Department of Statistics, Stanford University, Stanford, CA 94305.
Department of Pathology, Stanford University, Stanford, CA 94305.
Proc Natl Acad Sci U S A. 2017 Oct 24;114(43):11368-11373. doi: 10.1073/pnas.1714097114. Epub 2017 Oct 9.
Maintaining a robust blood product supply is an essential requirement to guarantee optimal patient care in modern health care systems. However, daily blood product use is difficult to anticipate. Platelet products are the most variable in daily usage, have short shelf lives, and are also the most expensive to produce, test, and store. Due to the combination of absolute need, uncertain daily demand, and short shelf life, platelet products are frequently wasted due to expiration. Our aim is to build and validate a statistical model to forecast future platelet demand and thereby reduce wastage. We have investigated platelet usage patterns at our institution, and specifically interrogated the relationship between platelet usage and aggregated hospital-wide patient data over a recent consecutive 29-mo period. Using a convex statistical formulation, we have found that platelet usage is highly dependent on weekday/weekend pattern, number of patients with various abnormal complete blood count measurements, and location-specific hospital census data. We incorporated these relationships in a mathematical model to guide collection and ordering strategy. This model minimizes waste due to expiration while avoiding shortages; the number of remaining platelet units at the end of any day stays above 10 in our model during the same period. Compared with historical expiration rates during the same period, our model reduces the expiration rate from 10.5 to 3.2%. Extrapolating our results to the ∼2 million units of platelets transfused annually within the United States, if implemented successfully, our model can potentially save ∼80 million dollars in health care costs.
维持充足的血液制品供应是现代医疗体系保证最佳患者护理的基本要求。然而,日常血液制品的使用量难以预测。血小板制品的日用量最不稳定,保质期短,生产成本、检测成本和储存成本也最高。由于绝对需求、每日需求不确定和保质期短的综合影响,血小板制品经常因过期而浪费。我们的目标是建立和验证一个统计模型,以预测未来的血小板需求,从而减少浪费。我们已经研究了我们机构的血小板使用模式,并特别研究了最近连续 29 个月血小板使用与综合医院范围内患者数据之间的关系。使用凸统计公式,我们发现血小板的使用高度依赖于工作日/周末模式、各种异常全血细胞计数测量的患者数量以及特定地点的医院人口统计数据。我们将这些关系纳入数学模型中,以指导采集和订购策略。该模型在避免短缺的同时最大限度地减少因过期而造成的浪费;在相同时期,我们的模型每天结束时剩余的血小板单位数保持在 10 个以上。与同期的历史过期率相比,我们的模型将过期率从 10.5%降低到 3.2%。如果我们的模型在美国每年约 200 万单位的血小板输注中成功实施,那么我们可以潜在地节省约 8 亿美元的医疗保健费用。