The Impact of Telehealth on Primary Care Physician Panel Sizes: A Modeling Study.

INTRODUCTION: Most research on the use of telehealth in lieu of in-office visits has focused on its growth, its impact on access, and the experience of physicians and patients. One important issue that has not gotten much attention is the potential for telehealth to significantly increase physician capacity by reducing nonvalue adding activities and patient no-shows. We explore this in this article. METHODS: We use data from the electronic health records of 2 health care systems and information gathered from family medicine physician focus groups to develop estimates of visit durations and no-show rates for tele-visits. We use these in a simulation model to determine how patient panel sizes could be increased while maintaining high levels of access by substituting tele-visits for in-person visits. RESULTS: We found that tele-visits reduce the nonvalue-added time physicians spend with patients as well as patient no-shows. At current levels of tele-visit utilization, the use of tele-visits may translate into more than a 10% increase in patient panel sizes assuming a modest reduction in visit durations and no-shows, and as much as a 30% increase assuming that half of all visits could be effectively conducted virtually and result in a greater reduction in visit durations and no-shows. DISCUSSION: Our study provides evidence that a major benefit of using telehealth for many routine encounters is a reduction in wasted physician time and a substantial increase in the number of patients that a primary care physician can care for without jeopardizing access to care.

Morphing-Enabled Path Planning for Flying Tensegrity Robots as a Semidefinite Program.

The development of deformable drones is of high importance but presents significant challenges. Such drones can be based on tensegrity structures, which leaves open the questions of configuration-space path planning for such robots. In this paper we propose a method that takes advantage of a simplified encoding of the drone's shape, allowing to turn the path planning into a sequence of semidefinite programs. The mapping from the simplified description and the actual tensegrity configuration is done via a data-driven method, using a pre-computed dataset of statically stable configurations and their outer Löwner-John ellipsoids, as well as eigendecompositions of the ellipsoid matrices. Together it allows rapid containment check, whose computational cost depends linearly on the number of dataset entries. Thus, the proposed method offloads computationally-intensive parts to the offline dataset generation procedure, speeding up the algorithm execution.

State Observer for Linear Systems with Explicit Constraints: Orthogonal Decomposition Method.

In this paper, an orthogonal decomposition-based state observer for systems with explicit constraints is proposed. State observers have been an integral part of robotic systems, reflecting the practicality and effectiveness of the dynamic state feedback control, but the same methods are lacking for the systems with explicit mechanical constraints, where observer designs have been proposed only for special cases of such systems, with relatively restrictive assumptions. This work aims to provide an observer design framework for a general case linear time-invariant system with explicit constraints, by finding lower-dimensional subspaces in the state space, where the system is observable while giving sufficient information for both feedback and feed-forward control. We show that the proposed formulation recovers minimal coordinate representation when it is sufficient for the control law generation and retains non-minimal coordinates when those are required for the feed-forward control law. The proposed observer is tested on a flywheel inverted pendulum and on a quadruped robot Unitree A1.

Primary care physician shortages could be eliminated through use of teams, nonphysicians, and electronic communication.

Most existing estimates of the shortage of primary care physicians are based on simple ratios, such as one physician for every 2,500 patients. These estimates do not consider the impact of such ratios on patients' ability to get timely access to care. They also do not quantify the impact of changing patient demographics on the demand side and alternative methods of delivering care on the supply side. We used simulation methods to provide estimates of the number of primary care physicians needed, based on a comprehensive analysis considering access, demographics, and changing practice patterns. We show that the implementation of some increasingly popular operational changes in the ways clinicians deliver care-including the use of teams or "pods," better information technology and sharing of data, and the use of nonphysicians-have the potential to offset completely the increase in demand for physician services while improving access to care, thereby averting a primary care physician shortage.

Providing timely access to care: what is the right patient panel size?

BACKGROUND: Delays for appointments are prevalent, resulting in patient dissatisfaction, higher costs, and possible adverse clinical consequences. A "just-in-time" approach to patient scheduling, called advanced access, has been effective in reducing delays in multiple clinical settings. Offering most patients appointments on the same day requires achieving an appropriate balance between supply of and demand for appointments, but no methods have been previously proposed to determine what this balance should be. METHODS: A measure of balance is termed the overflow frequency level--the fraction of days when demand exceeds the average number of appointment slots available. A probability model was developed to estimate this measure for any practice. The model can be used in identifying an appropriate panel size or, conversely, the physician capacity needed to provide timely access. RESULTS: Delays for appointments will be excessive unless the ratio of the average daily demand for appointments to the average daily capacity is less than one. This ratio's appropriate value is dependent on the desired overflow frequency level, which indicates the fraction of days for which physician overtime would be necessary to offer most patients same-day appointments. A table provides suggested panel sizes for a range of practice types, and a spreadsheet file is available on request to help determine panel size or physician capacity in any specific situation. CONCLUSION: The simple probability model can be used to improve the timeliness of care while considering the constraints on physicians' working hours.