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Most traditional cell formation procedures ignore any changes in demand over time caused by product redesign and uncertainties due to volume variation, part mix variation, and resource unreliability.
Nikoofarid and Aalaei (2012) designed a mathematical model for production planning in a dynamic virtual cellular manufacturing (DVCM) considering demand and part mix variation, machine capacity and as machine and worker availability as the main constraints.
Third, case mix variation is difficult to control for since risk scores have not been developed for secondary transfers.
We studied uncomplicated CABG procedures to allow for valid comparisons across the three sites without the confounding effects of different risk stratification and patient mix variation among the sites.
Although the HMO in Sao Paulo did not show any service change during the observed period and the referees and specialties available in the hospitals were maintained constant, we cannot guarantee that some case mix variation could have exerted influence in our analysis.
However, the present analysis was able to look at the most likely causes of possible case mix variation between the groups of general practices (age, sex, types of cancer, and socioeconomic group), but as in any observational study, there remains, in principle, the possibility of bias from unknown confounding variables.
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33 34 Variations in our data are likely to be a summation of variations in the quality of care, variations due to patient case mix, variations in the used definitions/data quality and chance.
A higher percentage of patients with a UL-LOS compared to the national average, after a correction is made for case mix variations, may indicate shortcomings in the quality or safety of care delivered by the hospital.
As expected, along with wide differences in the workforce skill mix, variations were also observed in the level of professional education and training among surveyed health workers, both within and across countries.
Zurn et al. show skill-mix variation within countries with similar economic development, and Gupta et al. show skill-mix variation within and between developed and transitional-economy countries [ 6, 7].
Further studies to determine the extent to which case-mix variation accounts for these observations are warranted.
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