Identifying proactive ICU patient admission, transfer and diversion policies in a public-private hospital network

Simple item page
dc.contributor.authorMarquinez, Jose Tomas
dc.contributor.authorSaure, Antoine
dc.contributor.authorCataldo, Alejandro
dc.contributor.authorFerrer, Juan-Carlos
dc.date.accessioned2025-01-20T22:17:28Z
dc.date.available2025-01-20T22:17:28Z
dc.date.issued2021
dc.description.abstractManagement of hospital beds is a high-impact issue for two-tier healthcare systems, due principally to their critical importance and high costs. Bed capacity in the public sector is generally insufficient to provide immediate care to all critical patients and thus a significant proportion of public expenditure is assigned to the diversion of patients for treatment in the private sector. We formulate and approximately solve a discounted infinite-horizon Markov Decision Process (MDP) that seeks to identify cost-effective policies for transferring ICU patients between hospitals or diverting them to private clinics. The solution approach employs an affine architecture for approximating the value function of the MDP model and solves the equivalent linear programming model using column generation. The approach can handle a high level of dimensionality, enabling it to consider the arriving patients' many different diagnostic groups and their corresponding lengths of stay. The decisions generated through this approach often differ from the intuitive ones produced in a typical day-by-day decision process, that does not consider the impact of the current day's decisions on the future performance of the system. In particular, the resulting policies will in many cases proactively transfer patients to a different public facility or divert them to a private one even though the hospital they first arrived at had beds available. The performance of the proposed method was evaluated by simulating a case study based on data from a hospital network in Santiago, Chile, producing savings of almost 49% due mostly to reduced usage of private services.
dc.description.abstract(c) 2021 Elsevier B.V. All rights reserved.
dc.fuente.origenWOS
dc.identifier.doi10.1016/j.ejor.2021.02.045
dc.identifier.eissn1872-6860
dc.identifier.issn0377-2217
dc.identifier.urihttps://doi.org/10.1016/j.ejor.2021.02.045
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/94549
dc.identifier.wosidWOS:000661773000020
dc.issue.numero1
dc.language.isoen
dc.pagina.final320
dc.pagina.inicio306
dc.revistaEuropean journal of operational research
dc.rightsacceso restringido
dc.subjectOR in health services
dc.subjectIntensive care units
dc.subjectHospital network
dc.subjectPatient admission and transfer policies
dc.subjectApproximate Dynamic Programming
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleIdentifying proactive ICU patient admission, transfer and diversion policies in a public-private hospital network
dc.typeartículo
dc.volumen295
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
Files
Collections
Artículos de revistas