A flexible method for optimising sharing of healthcare resources and demand in the context of the COVID-19 pandemic.
A flexible method for optimising sharing of healthcare resources and demand in the context of the COVID-19 pandemic.
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DOI：
10.1371/journal.pone.0241027
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Danon L
中科院分区：
文献类型：
--
作者：
Lacasa L;Challen R;Brooks-Pollock E;Danon L
随着COVID-19病例数量持续增长，当地医疗服务面临需要重症监护的患者不堪重负的风险。我们开发并实施了一种算法，以提供最佳的重新路由策略，无论是转移需要重症监护病房（ICU）或呼吸机的患者，转移的可行性的约束。我们验证我们的方法与现实的数据，从英国和西班牙。在英国，我们认为国家卫生服务在信任的水平，并定义了一个4-正则几何图，表示任何给定的信任的四个最近的邻居。在西班牙，我们在自治社区的层面上粗粒度的医疗保健系统，并提取类似的联系网络。通过随机搜索优化，我们确定了最佳的负载分担策略，其中要最小化的成本函数是基于高于容量的ICU单元的总数。我们的框架是通用的，灵活的，允许额外的标准，替代成本函数，并可以扩展到ICU单位或呼吸机以外的其他资源。假设一个统一的ICU需求，我们表明，它是可能的，使访问ICU的多达1000个额外的情况下，在英国在一个单一的步骤的算法。在更现实和异构的需求下，我们的方法能够在西班牙系统中仅使用本地共享每步平衡约600张床位，并使用全国共享超过1300张床位，从而可能挽救这些生命中的很大一部分，否则无法进入ICU。
As the number of cases of COVID-19 continues to grow, local health services are at risk of being overwhelmed with patients requiring intensive care. We develop and implement an algorithm to provide optimal re-routing strategies to either transfer patients requiring Intensive Care Units (ICU) or ventilators, constrained by feasibility of transfer. We validate our approach with realistic data from the United Kingdom and Spain. In the UK, we consider the National Health Service at the level of trusts and define a 4-regular geometric graph which indicates the four nearest neighbours of any given trust. In Spain we coarse-grain the healthcare system at the level of autonomous communities, and extract similar contact networks. Through random search optimisation we identify the best load sharing strategy, where the cost function to minimise is based on the total number of ICU units above capacity. Our framework is general and flexible allowing for additional criteria, alternative cost functions, and can be extended to other resources beyond ICU units or ventilators. Assuming a uniform ICU demand, we show that it is possible to enable access to ICU for up to 1000 additional cases in the UK in a single step of the algorithm. Under a more realistic and heterogeneous demand, our method is able to balance about 600 beds per step in the Spanish system only using local sharing, and over 1300 using countrywide sharing, potentially saving a large percentage of these lives that would otherwise not have access to ICU.
影响因子：
168.9
作者：
Remuzzi, Andrea;Remuzzi, Giuseppe
通讯作者：
Remuzzi, Giuseppe
影响因子：
1.1
作者：
Berenbrink, Petra;Cooper, Colin;Sauerwald, Thomas
通讯作者：
Sauerwald, Thomas
影响因子：
1.6
作者：
VARIAN, HR
通讯作者：
VARIAN, HR