Optimal Two-Tier Outpatient Care Network Redesign With a Real-World Case Study of Shanghai
Optimal Two-Tier Outpatient Care Network Redesign With a Real-World Case Study of Shanghai
复制标题
以上海实际案例研究优化两级门诊网络重新设计
DOI：
10.1109/tase.2022.3198484
复制
发表时间：
2022-09-07
影响因子：
5.6
通讯作者：
Xie，Xiaoqing
中科院分区：
文献类型：
--
作者：
Deng，Yewen;Li，Na;Xie，Xiaoqing
在许多国家，医疗保健能力短缺导致难以获得医疗服务。此外，这些国家经常出现的快速城市化加剧了保健能力与需求之间的不平衡。解决上述挑战的一种方法是扩大总容量并在空间上重新分配容量。在本研究中，我们研究了在由多个中心医院和区医院组成的双层门诊系统中定位新医院，并将现有的区医院升级为中心医院的问题。我们用一个离散位置优化模型来表述这个问题。为了参数化优化模型，我们使用多项logit模型来表征个体患者不同的医院选择，并相应地量化每个医院的患者到达率。为了解决难的非线性组合优化问题，我们建立了一个排队网络模型来近似医院位置对患者流的影响。然后，我们提出了一种多保真度优化方法，该方法将上述排队网络模型作为代理，并将自行开发的随机模拟作为高保真度模型。本文以上海市为例，分析了人口中心的出现、政府预算的变化以及考虑不同年龄和收入水平的患者对护理网络设计的影响。从业人员注意：我们的工作重点是在两层护理网络中改善全系统的护理访问。我们相信，我们的工作可以有效地为全市医疗保健系统规划者开发位置分析工具。我们还认为，基于中国上海现实世界医院选择实验数据的案例研究进一步加强了本研究的重要性，上海是一个医疗保健能力与需求不平衡的地区。我们的案例研究有望对护理设施的扩展和分散提出建议，以更好地与住宅社区的空间分布和患者的医院选择行为保持一致。
Healthcare capacity shortage contributes to poor access in many countries. Moreover, rapid urbanization often occurring in these countries has exacerbated the imbalance between healthcare capacity and need. One way to address the above challenge is expanding the total capacity and redistributing the capacity spatially. In this research, we studied the problem of locating new hospitals in a two-tier outpatient care system comprising multiple central and district hospitals, and upgrading existing district hospitals to central hospitals. We formulated the problem with a discrete location optimization model. To parameterize the optimization model, we used a multinomial logit model to characterize individual patients’ diverse hospital choice and to quantify the patient arrival rates at each hospital accordingly. To solve the hard nonlinear combinatorial optimization problem, we developed a queueing network model to approximate the impact of hospital locations on patient flows. We then proposed a multi-fidelity optimization approach, which involves both the aforementioned queuing network model as a surrogate and a self-developed stochastic simulation as the high-fidelity model. With a real-world case study of Shanghai, we demonstrated the changes in the care network and examined the impacts on the network design by population center emergence, governmental budget change and considering patients with different age groups or income levels. Note to Practitioners—Our work focuses on improving system-wide care access in a two-tier care network. We believe that our work can lead to effective development of a location analytics tool for city-wide healthcare system planners. We also think the importance of this study is further strengthened by the case studies based on real-world hospital choice experimental data from Shanghai, China, a region suffering from the imbalance between healthcare capacity and need. Our case studies are expected to make recommendations on care facility expansion and dispersion to better align with the spatial distribution of residential communities and patient hospital choice behavior.