Telfer School of Management, University of Ottawa, Ottawa, ON, Canada.
Health Care Manag Sci. 2012 Jun;15(2):91-102. doi: 10.1007/s10729-011-9185-4. Epub 2011 Nov 17.
Managing an efficient outpatient clinic can often be complicated by significant no-show rates and escalating appointment lead times. One method that has been proposed for avoiding the wasted capacity due to no-shows is called open or advanced access. The essence of open access is "do today's demand today". We develop a Markov Decision Process (MDP) model that demonstrates that a short booking window does significantly better than open access. We analyze a number of scenarios that explore the trade-off between patient-related measures (lead times) and physician- or system-related measures (revenue, overtime and idle time). Through simulation, we demonstrate that, over a wide variety of potential scenarios and clinics, the MDP policy does as well or better than open access in terms of minimizing costs (or maximizing profits) as well as providing more consistent throughput.
管理高效的门诊诊所通常会因为大量的失约率和不断延长的预约前置时间而变得复杂。一种避免因失约而造成浪费的方法被称为开放或提前预约。开放预约的本质是“今天满足今天的需求”。我们开发了一个马尔可夫决策过程（MDP）模型，该模型表明较短的预约窗口明显优于开放预约。我们分析了一些场景，这些场景探讨了患者相关措施（前置时间）和医生或系统相关措施（收入、加班和空闲时间）之间的权衡。通过模拟，我们证明在广泛的潜在场景和诊所中，MDP 策略在最小化成本（或最大化利润）以及提供更一致的吞吐量方面与开放预约一样或更好。
