Healthcare Resource Planning for Senior and End-of-life Patients

自2016年以来，加拿大人口老龄化，老年人数量超过儿童。在过去的几年里，死亡原因发生了变化，这主要是由于慢性病的医疗治疗有所改善。这种慢性疾病导致人们寿命延长，但有更多的限制寿命的条件，这导致对医疗设施和人员的更多需求。医院拥堵和过度拥挤一直是加拿大医疗体系的一个主要问题。造成这一问题的主要原因之一是，患有限制生命和慢性疾病的患者占用了住院病床，但不再需要医院提供的密集资源或服务，并准备好出院到非急性护理提供者，如家庭护理和长期护理设施和收容所。然而，由于长期护理设施中可用床位的缺乏或短缺，他们最终会在占用住院床位的医院等待数天、数周，有时甚至数月。这导致了各种问题，如阻塞其他患者的通道，取消选择性手术，增加急诊科等待时间，救护车卸载延迟，以及许多成本影响。这项研究建议旨在通过规划LTC设施和所需的人力资源来解决上述问题。这项研究的结果将有助于政策制定者和医疗管理人员更好地观察医院拥堵、能力短缺和长期护理专业人员供需失衡等现有和不断扩大的问题。在我的研究中，我提出了一个在随机环境下设施选址、需求分配和未来几年LTC资源能力扩展的新模型。该模型将根据患者的健康状况确定患者出院后的目的地(长期护理、临终关怀、家庭护理)。此外，我还提出了新的模式，以规划为限制生命和临终病人提供护理所需的人力资源。团队方法将对这些患者起到最好的作用，我的模型将检查团队的组成，以提供急性护理病房的护理。我的模型将考虑现有的劳动力，并探索诸如新劳动力的教育、现有劳动力的晋升和退休、招聘的时间表等问题。我将所有医疗机构视为一个链条，其中一个单位的效率低下将影响其他单位的表现。我的研究计划将通过专注于规划老年人的医疗设施来提高这一连锁店的效率。总体而言，我的研究计划将在医疗保健操作的方法和实践方面取得重大进展。这项研究将改善老年人和临终病人获得LTC设施的机会。因此，加拿大患者及其照顾者的医院效率和生活质量将得到提高。

Canada has an aging population with seniors outnumbered children since 2016. Over the past years, there was a change in the causes of deaths, mostly due to the improvements in medical treatments for chronic diseases. Such chronic conditions result in people living longer, but with more life-limiting conditions, which leads to more needs for healthcare facilities and personnel. Hospital congestion and over-crowdedness have been a major problem of the Canadian healthcare system. One of the main contributors to this problem is occupying the inpatient beds by patients who suffer from life-limiting and chronic conditions, but no longer require the intensity of resources or services provided in the hospital and are ready to be discharged to non-acute care providers such as home care and Long-Term Care (LTC) facilities and hospices. However, due to lack or shortage of available beds in LTC facilities, they end up waiting days, weeks, and even sometimes months in hospitals occupying in-patient beds. This results in various issues such as blocking access of other patients, cancellation of elective surgeries, increasing the emergency department wait times, ambulance offload delay, and many cost implications. This research proposal aims at dealing with the problem mentioned above by planning for LTC facilities and human resources needed for them. The results of this research will help policymakers and healthcare management to better observe the existing and enlarging problems of hospital congestion, shortage of capacity, and the imbalance between supply and demand for LTC professionals. In my research, I propose a novel model for facility location, demand allocation, and capacity expansion of LTC resources over the next years in a stochastic setting. The model will identify the destination of the patient (LTC, hospice, homecare) after discharge based on the patient's health situation. In addition, I propose new models to plan for human resources needed to provide care to life-limiting and end-of-life patients. A team approach will work the best for these patients, and my models will examine the team composition to provide the care out of acute-care units. My models will take into account the existing workforce and explore issues such as the education of the new workforce, the promotion, and retirement of the current workforce, the timeline for hiring, etc. I see all healthcare facilities as a chain in which inefficiency in one unit will affect the performance of other units. My program of research will improve the efficiency of this chain by focusing on planning for senior's healthcare facilities. Overall, my research program will lead to significant methodological and practical advancements in healthcare operations. This research will improve access to LTC facilities for seniors and end-of-life patients. Therefore, hospital efficiency and quality of life for Canadian patients and their caregivers will be enhanced.