UVA’s University Physicians Charlottesville Clinic Performance; Aspects of Health

Bram, Mason, School of Engineering and Applied Science, University of Virginia
Riggs, Robert, EN-SIE, University of Virginia
Baritaud, Catherine, EN-Engineering and Society, University of Virginia

The goal of this portfolio was to improve the health of individuals and reduce patient demand for medical facilities. A problem arose during the Covid-19 pandemic when medical facilities experienced demand that exceeded their capacity. Patients needing care had to be turned away because others were more critical. This goal was broken down into two perspectives. From one side, the technical aspect was to identify operational problem areas in medical facilities to increase patient capacity in the short term. From the other, the STS aspect took a societal health perspective to reduce patient demand in the long term. Like other medical facilities, UVA’s University Physicians Charlottesville (UPC) clinic experienced an increase in patient demand during the Covid-19 pandemic and needed an operational solution to expand their patient capacity. The technical report discussed UPC’s key performance metrics between April and June 2022 to identify their operational problem areas. Following this, the STS paper discussed obesity from a sociotechnical perspective to better understand its impact on health.
Defining the problem for the technical report, UPC’s medical director, Dr. Kimberly Dowdell, MD, wanted to understand the operational inefficiencies of the clinic. Statistical analysis was performed using timestamp, estimated appointment length, patient demographic, visit type, and provider data from UVA’s electronic health record between April and June 2022. Minitab software was used to compare population values to determine the factors that affected the duration a patient was seen.
Results show that visit type, time of day, and provider impact the duration of an appointment. Sick Visit and Follow Up visit types are scheduled for 40 minutes, however a two-population t test showed that these appointment types have a median duration of 76 minutes. The extended appointment length could have been due to lengthy conversations regarding the fear surrounding Covid-19, vaccinations, or simply because it was human interaction for patients during a time of isolation. A Tukey’s Pairwise Comparison Test showed that patients are roomed for 3.8 minutes shorter for appointments in the morning. An analysis of variance found that Dr. Lehtinen, MD, had a statistically significant higher mean rooming time compared to other providers. However, there were limitations to these findings that must be considered before making operational changes as this report did not account for patient satisfaction nor operational finances.
Switching to the STS perspective, research aimed to answer the question: How can researching obesity from a sociotechnical perspective create a better definition for health? Defining health and understanding factors of obesity are critical to decreasing patient demand on medical facilities in the long term. Pacey’s Triangle of Technology framework was used to identify technical, cultural, and organizational aspects of health.
Pacey introduces the idea of a restrictive and general definition for technology. The restrictive definition of a technology is based on its components and is what people normally think of when defining technology. However, this only represents the technical aspect. The culmination of the three aspects, technical, cultural, and organizational, is the general definition of a technology. Technology was compared to health practice, defined for the purpose of the STS study as the state of the human body in equilibrium. The technological aspect of health is represented by quantifiable measures such as body weight and BMI that define the health of an individual from the medical perspective. These metrics further classify individuals within weight groups defined by the CDC: underweight, normal weight, overweight, or obese. The public ordinarily defines health as this aspect alone. The cultural aspect is the harmful bodyweight stigma that arises from this practice. The organizational aspect is the social and physical environment surrounding health. From the NYT, journalists Barry and Stolberg, shared the stories of successful politicians paving the way for mental health. This showed that judgements on health cannot be based off appearances alone. Social influence affects one’s mental health, while a physical environment affects the physical aspect of health. The culmination of these three aspects creates the general definition of health in which aspects must be addressed in congruence.
The technical analysis found key areas that impacted the duration of a patient seen at the UPC clinic. The STS study concluded that solving this public health crisis is not an easy task and through Pacey’s Triangle of Technology framework, three points of health were identified. Initiated by a problem that arose in medical facilities during Covid-19, the coupling of this technical and sociotechnical report found factors that aim to improve medical capacity in the short term and the health of individuals in the long term.

BS (Bachelor of Science)
Pacey's Triangle of Technology, Health, Obesity, Clinic Performance Metrics

School of Engineering and Applied Science
Bachelor of Science in Systems and Information Engineering
Technical Advisor: Robert Riggs
STS Advisor: Catherine Baritaud

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