Document Type : Research articles

Authors

Department of Industrial Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran

Abstract

Background: Reducing patient length of stay (LOS) in hospitals reduces the high cost of chemotherapy and increases patient satisfaction. Objectives: This study aimed to present a combined model based on value engineering and the house of quality (HOQ) to improve the chemotherapy processes of hospitalized adult patients and reduce LOS and costs.
Methods: In this study, a cost and time model of the functions was drawn for the current chemotherapy process, and as a result, the duration and costs of a chemotherapy course were obtained. A simulation model corresponding to the process map was developed and the output was validated. Afterward, using the HOQ method in the pre-study stage and collecting value engineering information, the real needs and wants of patients were transformed into quality characteristics, and by implementing other value engineering steps, 5 scenarios were presented to improve the process and were tested on the validated simulation model.
Results: The presented scenarios included the process scenario (17.29% time reduction and $ 537,827 cost reduction), medication delivery scenario (7.3% time reduction and $ 268,231 cost reduction), technology scenario (2% time reduction and $ 59,640 cost reduction), end-of-life scenario (20% reduction in time and no cost savings), home care scenario (14% reduction in time and $ 329,020 cost reduction).
Conclusion: By implementing these scenarios and improving the process, the treatment protocol was changed and caused an increase in the value index of the patient's LOS and a decrease in the waiting list for chemotherapy in the above hospital.

Keywords

  1. Singh VK, Rathi R, Kaul A. The value engineering way: a case of industrial fans. in advances in intelligent manufacturing. Springer:Singapore; 2020.
  2. Ray B. Value engineering: a practical approach to managing cost in critical care. Health Administrator; 2011.‏
  3. Behncke FG, Maisenbacher S, Maurer M. Extended model for integrated value engineering. Procedia Comput Sci. 2014;28:781-8. doi:‏ 10.1016/j.procs.2014.03.093.
  4. Parsa A, Gray D. Economic evaluation of coronary heart disease (CHD): expectations and challenges in UK and Iran, Iranian Journal of Public Health, 2005:24-24.‏
  5. Shih YC, Chien CR. A review of cost communication in oncology: patient attitude, provider acceptance, and outcome assessment. Cancer. 2017;123(6):928-39. doi: 10.1002/cncr.30423. [PubMed: 27893929].
  6. Ginting R, Tarigan U, Panjaitan N. Integration of quality function deployment and value engineering: A case study of designing a texon cutting tool. Songklanakarin J Sci Technol. 2020;42(4):771-9.‏
  7. JebelAmeli M S, Mohammad Sadeghi A R, role in achieving the goals of the project value engineering, value engineering and Cost Management Conference, Tehran, Institute for designers, gamers, reference value engineering knowledge, 2014
  8. Luengo-Fernandez R, Leal J, Gray A, Sullivan R. Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol. 2013;14(12):1165-74.‏ doi: 10.1016/S1470-2045(13)70442-X. [PubMed: 24131614].
  9. Hofmarcher T, Lindgren P, Wilking N, Josson B. The cost of cancer in Europe 2018. Eur J Cancer. 2020;129:41-9.‏ doi: 10.1016/j.ejca.2020.01.011. [PubMed: 32120274].
  10. Mariotto AB, Robin Yabroff K, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst. 2011;103(2):117-28.‏ doi: 10.1093/jnci/djq495. [PubMed: 21228314].
  11. Benc M, Martinkova S, Rychtarova J, Fulka Jr J, Bartkova A, Fulka H, Laurincik J. Assessing the effect of interspecies oocyte nucleolar material dosage on embryonic development. Theriogenology. 2020 Oct 1;155:17-24..
  12. Rubin E, Mennemeyer ST, Desmond RA, Urist MM, Waterbor J, Heslin M J, et al. Reducing the cost of diagnosis of breast carcinoma: Impact of ultrasound and imaging‐guided biopsies on a clinical breast practice. Cancer. 2001;91(2):324-32. doi: 10.1002/1097-0142(20010115)91:2<324::aid-cncr1005>3.0.co;2-o. [PubMed: 11180078].
  13. Ghaffari A. Proposing optimal chemotherapy protocol for cancer treatment with metastasis by using SDRE based optimal control technique. Mech Eng. 2015;14(10):139-49.
  14. Edis E C, Karlıkaya C. The cost of lung cancer in Turkey. Tuberk ve Toraks. 2007;55(1):51-58.‏
  15. Mohammad Pourreza A, Harirchi I, Akbari F, Mahmoudi M, Investigating direct cost of treatment and non-therapeutic treatment of cancer patients admitted to Cancer Center of Imam Khomeini Hospital in Tehran. Quarterly Journal of Hospitals, 11, No. 1. Pages 50 – 1391
  16. Askarzade E, Adel A, Ebrahimipour H, Badiee Aval S, Pourahmadi E, Javan Biparva A. Epidemiology and cost of patients with cancer in Iran: 2018. Middle East J Cancer. 2019;10(4):362-71.‏ doi: 10.30476/MEJC.2019.83412.1162.
  17. Dahlberg L, Lundkvist J, Lindman H. Health care costs for treatment of disseminated breast cancer. Eur J Cancer. 2009;45(11):1987-91.‏ doi: 10.1016/j.ejca.2009.03.023. [PubMed: 19398326].
  18. Farokhi Noori MR, Holakouie Naieni K, Haghdoost AA, Emami A. Cost analysis for cancer subgroups in Kerman, IRAN. Iran J Epidemiology. 2012;8(1):62-70.
  19. Yokl Robert T. Are you sure you're realty practicing value analysis or are you doing something else and simply calling it that? Healthcare Purchasing New, 2006
  20. Santibañez P, Chow VS, French J, Puterman ML, Tyldesley S. Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency’s ambulatory care unit through simulation. Health Care Manag Sci. 2009;12(4):392-407.‏ doi: 10.1007/s10729-009-9103-1. [PubMed: 20058528].