Systems Engineering Analytic Models: Heterogeneous Adherence to the Healthcare Evidence Base
James Benneyan, Mechanical, Industrial, and Manufacturing Engineering; Northeastern University
Friday, January 29, 2010
This seminar is part of the Jones Seminars on Science, Technology, and Society series
Inconsistent provider and patient compliance with the medical evidence base across a wide range of chronic and acute conditions is highly variable, and enormously costly. Compliance performance to evidence based information is dismal. Only an estimated 54% of patients receive all recommended care, with patient instruction compliance being equally dismal (~50%) and accounting for ~$50 billion/year in drug hospitalizations and unplanned readmissions, 40% of nursing home admissions, and $2,000 per patient per year in physician office visits—a total of $177 billion. Systems engineering and operations research can play important roles in analysis and improvement of these problems, both as separate methodologies and in support of other ongoing approaches, such as seen in recent trends in collaborative testing and use of core measure sets and care process "bundles" for care quality evaluation, comparative ranking, pay-for-performance and other reimbursement schemes. After an overview of general work in this area, we discuss new probabilistic models, measurement techniques, and exact sequential likelihood ratio tests for studying the general adherence problem and accelerating process improvement. These methods are shown to result in significantly better performance than current approaches, in both speed and accuracy, and to also extend to risk adjusted mortality and other important concerns. Moreover, the popular widespread adoption of "all or none" compliance performance metrics is shown to have basic statistical concerns, possibly slowing improvement efforts.
About the Speaker
Dr. James Benneyan is professor of Industrial Engineering and Operations Research at Northeastern University, Executive Director of the VA New England Healthcare Engineering Partnership, Co-Director of the NSF Center for Healthcare Organizational Transformation, and founder of Northeastern University's Quality and Productivity research laboratory. His research foci and experience span healthcare systems engineering broadly—including statistical quality and safety methods, computer simulation modeling, novel exact risk-adjusted spatial-temporal surveillance methods, probabilistic optimization, and new risk-benefit and cost-effectiveness methodologies. Benneyan has jointly published over 75 papers in these areas; received 7 teaching, service, and research awards; and taught systems, mechanical, and design engineering to ages 6 through 60. Professor Benneyan is a Vice President of the Institute for Industrial Engineers (IIE), past President of the Society for Health Systems (SHS), faculty fellow at the Institute for Healthcare Improvement (IHI), operations research faculty in Northeastern's NSF-NSEC Center for High-Rate Nanomanufacturing, and fellow of SHS and the Healthcare Information and Management Systems Society. Prior to joining Northeastern, Jim was Senior Systems Engineer for Harvard Community Health Plan, consultant at Productivity Sciences Incorporated, and an industrial engineer at IBM and Digital Equipment Corporation. His primary funding sources include the National Science Foundation (NSF), National Institutes for Health (NIH), National Institute for Drug Abuse (NIDA), United Network for Organ Sharing (UNOS), the U.S. Air Force Surgeon General's Office, and the Agency for Healthcare Research and Quality (AHRQ).