Modelling and performance analysis of clinical pathways using the stochastic process algebra PEPA.
Modelling and performance analysis of clinical pathways using the stochastic process algebra PEPA.
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DOI：
10.1186/1471-2105-13-s14-s4
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发表时间：
2012
影响因子：
3
通讯作者：
Kitney R
中科院分区：
文献类型：
--
作者：
Yang X;Han R;Guo Y;Bradley J;Cox B;Dickinson R;Kitney R
如今，医院必须以有限的医务人员和设备为众多患者提供服务，同时保持医疗质量。临床路径信息学被认为是解决医院一系列挑战的有效途径。到目前为止，传统的研究缺乏一个数学模型来描述临床路径。现有的模糊描述不能充分准确地把握临床路径的复杂性，阻碍了临床路径的有效管理和进一步优化。鉴于此，本文提出了一种临床路径管理平台，帝国临床路径分析仪（ICPA）。通过扩展随机模型性能评价过程代数（PEPA），ICPA引入了临床路径特定模型：临床路径PEPA（CPP）。ICPA可以通过使用CPP从公共临床数据库和其他相关文档中提取信息来模拟临床路径的随机行为。因此，该临床路径的性能，包括其吞吐量，资源利用率和通过时间可以进行定量分析。一个典型的临床路径中风提取从英国医院被用来说明ICPA的有效性。使用ICPA测试了三个应用场景：1）冗余资源被识别并移除，从而以更少的成本维持被服务的患者数量; 2）患者通过时间被估计，提供患者在特定时间段内可以离开医院的可能性;（3）找出最大的输入病人数目，帮助医院决定在现有的资源分配下是否可以服务更多的病人。ICPA是临床路径管理的有效平台：1）ICPA可以描述临床路径中的各种组成部分（状态、活动、资源和约束），从而有助于正确理解临床路径中涉及的复杂性; 2）ICPA支持临床路径的性能分析，从而帮助医院有效地管理临床路径中的时间和资源。
Hospitals nowadays have to serve numerous patients with limited medical staff and equipment while maintaining healthcare quality. Clinical pathway informatics is regarded as an efficient way to solve a series of hospital challenges. To date, conventional research lacks a mathematical model to describe clinical pathways. Existing vague descriptions cannot fully capture the complexities accurately in clinical pathways and hinders the effective management and further optimization of clinical pathways. Given this motivation, this paper presents a clinical pathway management platform, the Imperial Clinical Pathway Analyzer (ICPA). By extending the stochastic model performance evaluation process algebra (PEPA), ICPA introduces a clinical-pathway-specific model: clinical pathway PEPA (CPP). ICPA can simulate stochastic behaviours of a clinical pathway by extracting information from public clinical databases and other related documents using CPP. Thus, the performance of this clinical pathway, including its throughput, resource utilisation and passage time can be quantitatively analysed. A typical clinical pathway on stroke extracted from a UK hospital is used to illustrate the effectiveness of ICPA. Three application scenarios are tested using ICPA: 1) redundant resources are identified and removed, thus the number of patients being served is maintained with less cost; 2) the patient passage time is estimated, providing the likelihood that patients can leave hospital within a specific period; 3) the maximum number of input patients are found, helping hospitals to decide whether they can serve more patients with the existing resource allocation. ICPA is an effective platform for clinical pathway management: 1) ICPA can describe a variety of components (state, activity, resource and constraints) in a clinical pathway, thus facilitating the proper understanding of complexities involved in it; 2) ICPA supports the performance analysis of clinical pathway, thereby assisting hospitals to effectively manage time and resources in clinical pathway.