Côté Murray J, Syam Siddhartha S, Vogel W Bruce, Cowper Diane C
Division of Health Care Policy and Research, Department of Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, CO 80045, USA.
Health Care Manag Sci. 2007 Sep;10(3):253-67. doi: 10.1007/s10729-007-9018-7.
For the Department of Veterans Affairs (VA), traumatic brain injury (TBI) is a significant problem facing active duty military personnel, veterans, their families, and caregivers. The VA has designated TBI treatment as one of its physical medicine and rehabilitation special emphasis programs, thereby providing a comprehensive array of treatment services to those military personnel and veterans with TBI. Timely treatment of TBI is critical in achieving maximal recovery, and being in geographical proximity to a medical center with specialized TBI treatment services is a major determinant of whether such treatment is utilized. We present a mixed integer programming model for locating TBI treatment units in the VA. This model was developed for the VA Rehabilitation Strategic Healthcare Group to assist in locating new TBI treatment units. The optimization model assigns TBI treatment units to existing VA medical centers while minimizing the sum of patient treatment costs, patient lodging and travel costs, and the penalty costs associated with foregone treatment revenue and excess capacity utilization. We demonstrate our model with VA TBI admission data from one of the VA's integrated service networks, and discuss the expected service and cost implications for a range of TBI treatment unit location options.
对于美国退伍军人事务部（VA）而言，创伤性脑损伤（TBI）是现役军人、退伍军人及其家属和护理人员面临的一个重大问题。VA已将TBI治疗指定为其物理医学与康复特别重点项目之一，从而为患有TBI的军人和退伍军人提供全面的治疗服务。及时治疗TBI对于实现最大程度的康复至关重要，而距离提供专门TBI治疗服务的医疗中心较近是能否利用此类治疗的一个主要决定因素。我们提出了一个用于在VA中定位TBI治疗单元的混合整数规划模型。该模型是为VA康复战略医疗集团开发的，以协助定位新的TBI治疗单元。该优化模型将TBI治疗单元分配到现有的VA医疗中心，同时将患者治疗成本、患者住宿和交通成本以及与放弃的治疗收入和产能过剩利用相关的惩罚成本之和降至最低。我们用来自VA一个综合服务网络的VA TBI入院数据展示了我们的模型，并讨论了一系列TBI治疗单元选址方案对预期服务和成本的影响。
