Health Care Management Science最新文献_第6页

Combining machine learning and optimization for the operational patient-bed assignment problem. 结合机器学习和优化的手术病床分配问题。

IF 3.6 3区医学

Health Care Management Science Pub Date : 2023-12-01 Epub Date: 2023-11-28 DOI: 10.1007/s10729-023-09652-5

Fabian Schäfer, Manuel Walther, Dominik G Grimm, Alexander Hübner

{"title":"Combining machine learning and optimization for the operational patient-bed assignment problem.","authors":"Fabian Schäfer, Manuel Walther, Dominik G Grimm, Alexander Hübner","doi":"10.1007/s10729-023-09652-5","DOIUrl":"10.1007/s10729-023-09652-5","url":null,"abstract":"Assigning inpatients to hospital beds impacts patient satisfaction and the workload of nurses and doctors. The assignment is subject to unknown inpatient arrivals, in particular for emergency patients. Hospitals, therefore, need to deal with uncertainty on actual bed requirements and potential shortage situations as bed capacities are limited. This paper develops a model and solution approach for solving the patient bed-assignment problem that is based on a machine learning (ML) approach to forecasting emergency patients. First, it contributes by improving the anticipation of emergency patients using ML approaches, incorporating weather data, time and dates, important local and regional events, as well as current and historical occupancy levels. Drawing on real-life data from a large case hospital, we were able to improve forecasting accuracy for emergency inpatient arrivals. We achieved up to 17% better root mean square error (RMSE) when using ML methods compared to a baseline approach relying on averages for historical arrival rates. We further show that the ML methods outperform time series forecasts. Second, we develop a new hyper-heuristic for solving real-life problem instances based on the pilot method and a specialized greedy look-ahead (GLA) heuristic. When applying the hyper-heuristic in test sets we were able to increase the objective function by up to 5.3% in comparison to the benchmark approach in [40]. A benchmark with a Genetic Algorithm shows also the superiority of the hyper-heuristic. Third, the combination of ML for emergency patient admission forecasting with advanced optimization through the hyper-heuristic allowed us to obtain an improvement of up to 3.3% on a real-life problem.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":" ","pages":"785-806"},"PeriodicalIF":3.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10709483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138444486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgical scheduling via optimization and machine learning with long-tailed data : Health care management science, in press. 通过长尾数据优化和机器学习进行手术排期：医疗管理科学》，出版中。

IF 3.6 3区医学

Health Care Management Science Pub Date : 2023-12-01 Epub Date: 2023-09-04 DOI: 10.1007/s10729-023-09649-0

Yuan Shi, Saied Mahdian, Jose Blanchet, Peter Glynn, Andrew Y Shin, David Scheinker

{"title":"Surgical scheduling via optimization and machine learning with long-tailed data : Health care management science, in press.","authors":"Yuan Shi, Saied Mahdian, Jose Blanchet, Peter Glynn, Andrew Y Shin, David Scheinker","doi":"10.1007/s10729-023-09649-0","DOIUrl":"10.1007/s10729-023-09649-0","url":null,"abstract":"Using data from cardiovascular surgery patients with long and highly variable post-surgical lengths of stay (LOS), we develop a modeling framework to reduce recovery unit congestion. We estimate the LOS and its probability distribution using machine learning models, schedule procedures on a rolling basis using a variety of optimization models, and estimate performance with simulation. The machine learning models achieved only modest LOS prediction accuracy, despite access to a very rich set of patient characteristics. Compared to the current paper-based system used in the hospital, most optimization models failed to reduce congestion without increasing wait times for surgery. A conservative stochastic optimization with sufficient sampling to capture the long tail of the LOS distribution outperformed the current manual process and other stochastic and robust optimization approaches. These results highlight the perils of using oversimplified distributional models of LOS for scheduling procedures and the importance of using optimization methods well-suited to dealing with long-tailed behavior.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":" ","pages":"692-718"},"PeriodicalIF":3.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10147078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pool testing with dilution effects and heterogeneous priors. 具有稀释效应和异质先验的集合测试

IF 3.6 3区医学

Health Care Management Science Pub Date : 2023-12-01 Epub Date: 2023-08-01 DOI: 10.1007/s10729-023-09650-7

Gustavo Quinderé Saraiva

引用次数: 0

Patient-to-nurse ratios: Balancing quality, nurse turnover, and cost. 病人与护士的比率:平衡质量、护士流动率和成本。

IF 3.6 3区医学

Health Care Management Science Pub Date : 2023-12-01 Epub Date: 2023-11-29 DOI: 10.1007/s10729-023-09659-y

David D Cho, Kurt M Bretthauer, Jan Schoenfelder

{"title":"Patient-to-nurse ratios: Balancing quality, nurse turnover, and cost.","authors":"David D Cho, Kurt M Bretthauer, Jan Schoenfelder","doi":"10.1007/s10729-023-09659-y","DOIUrl":"10.1007/s10729-023-09659-y","url":null,"abstract":"We consider the problem of setting appropriate patient-to-nurse ratios in a hospital, an issue that is both complex and widely debated. There has been only limited effort to take advantage of the extensive empirical results from the medical literature to help construct analytical decision models for developing upper limits on patient-to-nurse ratios that are more patient- and nurse-oriented. For example, empirical studies have shown that each additional patient assigned per nurse in a hospital is associated with increases in mortality rates, length-of-stay, and nurse burnout. Failure to consider these effects leads to disregarded potential cost savings resulting from providing higher quality of care and fewer nurse turnovers. Thus, we present a nurse staffing model that incorporates patient length-of-stay, nurse turnover, and costs related to patient-to-nurse ratios. We present results based on data collected from three participating hospitals, the American Hospital Association (AHA), and the California Office of Statewide Health Planning and Development (OSHPD). By incorporating patient and nurse outcomes, we show that lower patient-to-nurse ratios can potentially provide hospitals with financial benefits in addition to improving the quality of care. Furthermore, our results show that higher policy patient-to-nurse ratio upper limits may not be as harmful in smaller hospitals, but lower policy patient-to-nurse ratios may be necessary for larger hospitals. These results suggest that a \"one ratio fits all\" patient-to-nurse ratio is not optimal. A preferable policy would be to allow the ratio to be hospital-dependent.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":" ","pages":"807-826"},"PeriodicalIF":3.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138451369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Responding to the US opioid crisis: leveraging analytics to support decision making. 应对美国阿片类药物危机：利用分析支持决策。

IF 2.3 3区医学

Health Care Management Science Pub Date : 2023-12-01 Epub Date: 2023-10-07 DOI: 10.1007/s10729-023-09657-0

Margaret L Brandeau

引用次数: 0

Classification of patients with chronic disease by activation level using machine learning methods. 使用机器学习方法按激活水平对慢性病患者进行分类。

IF 3.6 3区医学

Health Care Management Science Pub Date : 2023-10-12 DOI: 10.2139/ssrn.4326943

Onur Demiray, E. Gunes, E. Kulak, E. Doğan, Ş. Karaketir, Serap Çi̇fçi̇li̇, M. Akman, S. Sakarya

{"title":"Classification of patients with chronic disease by activation level using machine learning methods.","authors":"Onur Demiray, E. Gunes, E. Kulak, E. Doğan, Ş. Karaketir, Serap Çi̇fçi̇li̇, M. Akman, S. Sakarya","doi":"10.2139/ssrn.4326943","DOIUrl":"https://doi.org/10.2139/ssrn.4326943","url":null,"abstract":"Patient Activation Measure (PAM) measures the activation level of patients with chronic conditions and correlates well with patient adherence behavior, health outcomes, and healthcare costs. PAM is increasingly used in practice to identify patients needing more support from the care team. We define PAM levels 1 and 2 as low PAM and investigate the performance of eight machine learning methods (Logistic Regression, Lasso Regression, Ridge Regression, Random Forest, Gradient Boosted Trees, Support Vector Machines, Decision Trees, Neural Networks) to classify patients. Primary data collected from adult patients (n=431) with Diabetes Mellitus (DM) or Hypertension (HT) attending Family Health Centers in Istanbul, Turkey, is used to test the methods. [Formula: see text] of patients in the dataset have a low PAM level. Classification performance with several feature sets was analyzed to understand the relative importance of different types of information and provide insights. The most important features are found as whether the patient performs self-monitoring, smoking and exercise habits, education, and socio-economic status. The best performance was achieved with the Logistic Regression algorithm, with Area Under the Curve (AUC)=0.72 with the best performing feature set. Alternative feature sets with similar prediction performance are also presented. The prediction performance was inferior with an automated feature selection method, supporting the importance of using domain knowledge in machine learning.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"1 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45488451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Process mining to discover patterns in patient outcomes in a Psychological Therapies Service. 过程挖掘以发现心理治疗服务中患者结果的模式。

IF 3.6 3区医学

Health Care Management Science Pub Date : 2023-09-01 Epub Date: 2023-05-16 DOI: 10.1007/s10729-023-09641-8

C Potts, R R Bond, J-A Jordan, M D Mulvenna, K Dyer, A Moorhead, A Elliott

{"title":"Process mining to discover patterns in patient outcomes in a Psychological Therapies Service.","authors":"C Potts, R R Bond, J-A Jordan, M D Mulvenna, K Dyer, A Moorhead, A Elliott","doi":"10.1007/s10729-023-09641-8","DOIUrl":"10.1007/s10729-023-09641-8","url":null,"abstract":"In the mental health sector, Psychological Therapies face numerous challenges including ambiguities over the client and service factors that are linked to unfavourable outcomes. Better understanding of these factors can contribute to effective and efficient use of resources within the Service. In this study, process mining was applied to data from the Northern Health and Social Care Trust Psychological Therapies Service (NHSCT PTS). The aim was to explore how psychological distress severity pre-therapy and attendance factors relate to outcomes and how clinicians can use that information to improve the service. Data included therapy episodes (N = 2,933) from the NHSCT PTS for adults with a range of mental health difficulties. Data were analysed using Define-Measure-Analyse model with process mining. Results found that around 11% of clients had pre-therapy psychological distress scores below the clinical cut-off and thus these individuals were unlikely to significantly improve. Clients with fewer cancelled or missed appointments were more likely to significantly improve post-therapy. Pre-therapy psychological distress scores could be a useful factor to consider at assessment for estimating therapy duration, as those with higher scores typically require more sessions. This study concludes that process mining is useful in health services such as NHSCT PTS to provide information to inform caseload planning, service management and resource allocation, with the potential to improve client's health outcomes.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 3","pages":"461-476"},"PeriodicalIF":3.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10186289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10602177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A reinforcement learning-based optimal control approach for managing an elective surgery backlog after pandemic disruption. 一种基于强化学习的优化控制方法，用于管理疫情中断后的择期手术积压。

IF 3.6 3区医学

Health Care Management Science Pub Date : 2023-09-01 Epub Date: 2023-04-21 DOI: 10.1007/s10729-023-09636-5

Huyang Xu, Yuanchen Fang, Chun-An Chou, Nasser Fard, Li Luo

{"title":"A reinforcement learning-based optimal control approach for managing an elective surgery backlog after pandemic disruption.","authors":"Huyang Xu, Yuanchen Fang, Chun-An Chou, Nasser Fard, Li Luo","doi":"10.1007/s10729-023-09636-5","DOIUrl":"10.1007/s10729-023-09636-5","url":null,"abstract":"Contagious disease pandemics, such as COVID-19, can cause hospitals around the world to delay nonemergent elective surgeries, which results in a large surgery backlog. To develop an operational solution for providing patients timely surgical care with limited health care resources, this study proposes a stochastic control process-based method that helps hospitals make operational recovery plans to clear their surgery backlog and restore surgical activity safely. The elective surgery backlog recovery process is modeled by a general discrete-time queueing network system, which is formulated by a Markov decision process. A scheduling optimization algorithm based on the piecewise decaying [Formula: see text]-greedy reinforcement learning algorithm is proposed to make dynamic daily surgery scheduling plans considering newly arrived patients, waiting time and clinical urgency. The proposed method is tested through a set of simulated dataset, and implemented on an elective surgery backlog that built up in one large general hospital in China after the outbreak of COVID-19. The results show that, compared with the current policy, the proposed method can effectively and rapidly clear the surgery backlog caused by a pandemic while ensuring that all patients receive timely surgical care. These results encourage the wider adoption of the proposed method to manage surgery scheduling during all phases of a public health crisis.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 3","pages":"430-446"},"PeriodicalIF":3.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10119544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10178435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3

Predicting drug shortages using pharmacy data and machine learning. 使用药房数据和机器学习预测药品短缺。

IF 3.6 3区医学

Health Care Management Science Pub Date : 2023-09-01 Epub Date: 2023-03-13 DOI: 10.1007/s10729-022-09627-y

Raman Pall, Yvan Gauthier, Sofia Auer, Walid Mowaswes

{"title":"Predicting drug shortages using pharmacy data and machine learning.","authors":"Raman Pall, Yvan Gauthier, Sofia Auer, Walid Mowaswes","doi":"10.1007/s10729-022-09627-y","DOIUrl":"10.1007/s10729-022-09627-y","url":null,"abstract":"Drug shortages are a global and complex issue having negative impacts on patients, pharmacists, and the broader health care system. Using sales data from 22 Canadian pharmacies and historical drug shortage data, we built machine learning models predicting shortages for the majority of the drugs in the most-dispensed interchangeable groups in Canada. When breaking drug shortages into four classes (none, low, medium, high), we were able to correctly predict the shortage class with 69% accuracy and a kappa value of 0.44, one month in advance, without access to any inventory data from drug manufacturers and suppliers. We also predicted 59% of the shortages deemed to be most impactful (given the demand for the drugs and the potential lack of interchangeable options). The models consider many variables, including the average days of a drug supply per patient, the total days of a drug supply, previous shortages, and the hierarchy of drugs within different drug groups and therapeutic classes. Once in production, the models will allow pharmacists to optimize their orders and inventories, and ultimately reduce the impact of drug shortages on their patients and operations.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 3","pages":"395-411"},"PeriodicalIF":3.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10009839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10190347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Optimization models for patient and technician scheduling in hemodialysis centers. 血液透析中心患者和技术人员调度的优化模型。

IF 3.6 3区医学

Health Care Management Science Pub Date : 2023-09-01 Epub Date: 2023-07-03 DOI: 10.1007/s10729-023-09642-7

Farbod Farhadi, Sina Ansari, Francisco Jara-Moroni

{"title":"Optimization models for patient and technician scheduling in hemodialysis centers.","authors":"Farbod Farhadi, Sina Ansari, Francisco Jara-Moroni","doi":"10.1007/s10729-023-09642-7","DOIUrl":"10.1007/s10729-023-09642-7","url":null,"abstract":"Patient and technician scheduling problem in hemodialysis centers presents a unique setting in healthcare operations as (1) unlike other healthcare problems, dialysis appointments have a steady state and the treatment times are determined in advance of the appointments, and (2) once the appointments are set, technicians will have to be assigned to two types of jobs per appointment: putting on and taking off patients (connecting to and disconnecting from dialysis machines). In this study, we design a mixed-integer programming model to minimize technicians' operating costs (regular and overtime costs) at large-scale hemodialysis centers. As this formulation proves to be computationally challenging to solve, we propose a novel reformulation of the problem as a discrete-time assignment model and prove that the two formulations are equivalent under a specific condition. We then simulate instances based on the data from our collaborating hemodialysis center to evaluate the performance of our proposed formulations. We compare our results to the current scheduling policy at the center. In our numerical analysis, we reduced the technician operating costs by 17% on average (up to 49%) compared to the current practice. We further conduct a post-optimality analysis and develop a predictive model that can estimate the number of required technicians based on the center's attributes and patients' input variables. Our predictive model reveals that the optimal number of technicians is strongly related to the time flexibility of patients and their dialysis times. Our findings can help clinic managers at hemodialysis centers to accurately estimate the technician requirements.","PeriodicalId":12903,"journal":{"name":"Health Care Management Science","volume":"26 3","pages":"558-582"},"PeriodicalIF":3.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10177950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0