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Review
. 2023 Oct 9;13(3):151-176.
doi: 10.1080/20476965.2023.2264348. eCollection 2024.

Fractured systems: a literature review of OR/MS methods applied to orthopaedic care settings and treatments

Matthew Howells  1 , Paul Harper  1 , Geraint Palmer  1 , Daniel Gartner  1
Affiliations
Review

Fractured systems: a literature review of OR/MS methods applied to orthopaedic care settings and treatments

Matthew Howells et al. Health Syst (Basingstoke). .

Abstract

Orthopaedic systems are facing an impending wave of increased pressures as a result of global ageing populations. This is compounded by the current stresses these services face, as a result of the COVID-19 pandemic, and increasing burden of musculoskeletal conditions. It is vital that measures are taken to alleviate the pressures on these systems, to ensure timely and quality access to care for patients. This literature review presents a taxonomic classification of the applications of Operational Research and Management Science (OR/MS) methodologies to orthopaedic care settings and treatments, covering the general, medical, and methodological context of each paper. Our structured search identified 492 relevant publications that have been included in our analysis. The results found a literature largely dominated by cost analysis applications, typically utilising Markov models or decision trees. Key gaps identified in this review include the lack of holistic modelling of orthopaedic systems and pathways, and limited applications to resource and capacity planning. The implications of our review are that researchers, healthcare professionals and managers can develop a research agenda to address these gaps, and enhance decision support in orthopaedics.

Keywords: Orthopaedics; literature review; management science; operational research.

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Conflict of interest statement

No potential conflict of interest was reported by the authors.

Figures

Figure 1.
Figure 1.
Flow diagram of the literature review search process.
Figure 2.
Figure 2.
Number of papers by their year of publication (up to 2021).
Figure 3.
Figure 3.
Number of papers by their JCR category. Papers with an ISSN not within any of the six JCR categories have been classified within ‘other’.
Figure 4.
Figure 4.
Number of papers by their JCR category and the Scopus search they were identified.
Figure 5.
Figure 5.
Number of papers by their continent of application.
Figure 6.
Figure 6.
Number of papers by their funding source.
Figure 7.
Figure 7.
Number of papers by the Trauma and orthopaedics specialties they consider.
Figure 8.
Figure 8.
Number of papers by their care area within the care system.
Figure 9.
Figure 9.
Number of papers by the number of parts of the secondary/tertiary pathway that they have modelled.
Figure 10.
Figure 10.
Number of papers by their modelling perspective.
Figure 11.
Figure 11.
Number of papers by their planning decision level.
Figure 12.
Figure 12.
Number of papers by research aims.
Figure 13.
Figure 13.
Number of papers by their research outcomes.
Figure 14.
Figure 14.
Number of papers by the level of implementation in a real world setting.
Figure 15.
Figure 15.
Number of papers by their research aims and level of implementation.
Figure 16.
Figure 16.
Number of papers by how the data was obtained.
Figure 17.
Figure 17.
Number of papers by their primary OR/MS method area.
Figure 18.
Figure 18.
Number of papers by their year published for the four most applied OR/MS areas (Markov models, decision analysis, soft OR, simulation).
Figure 19.
Figure 19.
Number of papers by their primary OR/MS method area and level of implementation.
Figure 20.
Figure 20.
Violin plots showing the distribution of the number of secondary/tertiary care areas modelled by each primary or area.
Figure 21.
Figure 21.
Number of papers by their research outcomes and primary OR/MS method.
See this image and copyright information in PMC

References

    1. Abdel, M. P., Miller L E, Hull S A, Coppolecchia A B, Hanssen A D, & Pagnano M W. (2020). Cost analysis of dual-mobility constructs in revision total hip arthroplasty: A European payer perspective. Orthopedics, 43(4), 250–255. issn: 01477447. 10.3928/01477447-20200625-01 - DOI - PubMed
    1. Aspland, E., Gartner, D., & Harper, P. (2021). Clinical pathway modelling: A literature review. Health Systems, 10(1), 1–23. 10.1080/20476965.2019.1652547 - DOI - PMC - PubMed
    1. Bai, J., Fügener, A., Schoenfelder, J., & Brunner, J. O. (2018). Operations research in intensive care unit management: A literature review. Health Care Management Science, 21(1), 1–24. 10.1007/s10729-016-9375-1 - DOI - PubMed
    1. Barber, P., & López-Valcárcel, B. G. (2010). Forecasting the need for medical specialists in Spain: Application of a system dynamics model. Human Resources for Health, 8(1), 8.24. 10.1186/1478-4491-8-24 - DOI - PMC - PubMed
    1. Barlow, B. T., McLawhorn, A. S., & Westrich, G. H. (2017). The cost-effectiveness of dual mobility implants for primary total hip arthroplasty: A computer-based cost- utility model. Journal of Bone and Joint Surgery - American Volume, 99(9), 768–777. 10.2106/JBJS.16.00109 - DOI - PubMed

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