West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610064, China.
Tencent.com, Shenzhen 518054, China.
Comput Math Methods Med. 2020 Jan 7;2020:8740457. doi: 10.1155/2020/8740457. eCollection 2020.
Hospital beds are a critical but limited resource shared between distinct classes of elective patients. Urgent elective patients are more sensitive to delays and should be treated immediately, whereas regular patients can wait for an extended time. Public hospitals in countries like China need to maximize their revenue and at the same time equitably allocate their limited bed capacity between distinct patient classes. Consequently, hospital bed managers are under great pressure to optimally allocate the available bed capacity to all classes of patients, particularly considering random patient arrivals and the length of patient stay. To address the difficulties, we propose data-driven stochastic optimization models that can directly utilize historical observations and feature data of capacity and demand. First, we propose a single-period model assuming known capacity; since it recovers and improves the current decision-making process, it may be deployed immediately. We develop a nonparametric kernel optimization method and demonstrate that an optimal allocation can be effectively obtained with one year's data. Next, we consider the dynamic transition of system state and extend the study to a multiperiod model that allows random capacity; this further brings in substantial improvement. Sensitivity analysis also offers interesting managerial insights. For example, it is optimal to allocate more beds to urgent patients on Mondays and Thursdays than on other weekdays; this is in sharp contrast to the current myopic practice.
医院床位是一种关键但有限的资源,在不同类别的择期患者之间共享。紧急择期患者对延迟更为敏感,应立即治疗,而常规患者可以等待更长时间。中国等国家的公立医院需要最大限度地提高收入,同时在不同的患者群体之间公平分配有限的床位容量。因此,医院床位管理者面临着为所有患者群体优化分配可用床位的巨大压力,特别是考虑到随机患者到达和患者住院时间的长度。为了解决这些困难,我们提出了数据驱动的随机优化模型,可以直接利用容量和需求的历史观测和特征数据。首先,我们提出了一个单期模型,假设已知容量;由于它恢复和改进了当前的决策过程,因此可以立即部署。我们开发了一种非参数核优化方法,并证明使用一年的数据可以有效地获得最佳分配。接下来,我们考虑系统状态的动态变化,并将研究扩展到允许随机容量的多期模型;这进一步带来了实质性的改进。敏感性分析也提供了有趣的管理见解。例如,在周一和周四为紧急患者分配更多床位比在其他工作日更优;这与当前的短视做法形成鲜明对比。