Applying operations research to optimize a novel population management system for cancer screening.
Applying operations research to optimize a novel population management system for cancer screening.
复制标题
应用运筹学来优化用于癌症筛查的新型人口管理系统。
DOI：
10.1136/amiajnl-2013-001681
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Atlas,StevenJ
中科院分区：
文献类型：
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作者：
Zai,AdrianH;Kim,Seokjin;Kamis,Arnold;Hung,Ken;Ronquillo,JeremiahG;Chueh,HenryC;Atlas,StevenJ
目的通过使用运筹学技术来模拟患者外展人员配置水平（代表、导航员）的变化、信息技术（IT）系统内用户工作流程的修改以及癌症筛查建议的变化，优化新的独立于就诊的、基于人群的癌症筛查系统（TopCare）。材料和方法TopCare 被建模为多服务器、多阶段排队系统。模拟实验采用了遵循下一事件时间提前机制的排队网络模型，其中对人员配置水平、IT工作流程设置和癌症筛查频率进行了系统调整，以评估其对每位患者逾期筛查的影响。结果TopCare将每位患者的平均逾期筛查数量从开始时的1.17个减少到模拟期间的0.86个，再减少到稳定状态下的0.23个。劳动力的增加提高了 TopCare 的效率。特别是，增加一名代表或导航人员级别后，筛查完成率分别提高了 1.3% 和 12.2%。相比之下，患者条目在代表和导航者列表上停留的时间的变化对逾期筛查影响不大。最后，延长筛查间隔可以减少患者层面的逾期筛查，从而提高 TopCare 内的效率，从而减少需要代表进行筛查的逾期患者数量，并提高代表完成筛查的比例。 结论 模拟人员配置、系统参数和临床输入的变化对护理有效性和效率的影响，可以为人口管理中有限资源的分配提供信息。
ObjectiveTo optimize a new visit-independent, population-based cancer screening system (TopCare) by using operations research techniques to simulate changes in patient outreach staffing levels (delegates, navigators), modifications to user workflow within the information technology (IT) system, and changes in cancer screening recommendations.Materials and methodsTopCare was modeled as a multiserver, multiphase queueing system. Simulation experiments implemented the queueing network model following a next-event time-advance mechanism, in which systematic adjustments were made to staffing levels, IT workflow settings, and cancer screening frequency in order to assess their impact on overdue screenings per patient.ResultsTopCare reduced the average number of overdue screenings per patient from 1.17 at inception to 0.86 during simulation to 0.23 at steady state. Increases in the workforce improved the effectiveness of TopCare. In particular, increasing the delegate or navigator staff level by one person improved screening completion rates by 1.3% or 12.2%, respectively. In contrast, changes in the amount of time a patient entry stays on delegate and navigator lists had little impact on overdue screenings. Finally, lengthening the screening interval increased efficiency within TopCare by decreasing overdue screenings at the patient level, resulting in a smaller number of overdue patients needing delegates for screening and a higher fraction of screenings completed by delegates.ConclusionsSimulating the impact of changes in staffing, system parameters, and clinical inputs on the effectiveness and efficiency of care can inform the allocation of limited resources in population management.