Department of Anesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Albert-Einstein-Allee 29, 89081, Ulm, Germany.
Faculty of Management, Economics and Social Sciences, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany.
Health Care Manag Sci. 2021 Dec;24(4):666-685. doi: 10.1007/s10729-021-09560-6. Epub 2021 Jun 10.
The intensive care unit (ICU) is one of the most crucial and expensive resources in a health care system. While high fixed costs usually lead to tight capacities, shortages have severe consequences. Thus, various challenging issues exist: When should an ICU admit or reject arriving patients in general? Should ICUs always be able to admit critical patients or rather focus on high utilization? On an operational level, both admission control of arriving patients and demand-driven early discharge of currently residing patients are decision variables and should be considered simultaneously. This paper discusses the trade-off between medical and monetary goals when managing intensive care units by modeling the problem as a Markov decision process. Intuitive, myopic rule mimicking decision-making in practice is applied as a benchmark. In a numerical study based on real-world data, we demonstrate that the medical results deteriorate dramatically when focusing on monetary goals only, and vice versa. Using our model, we illustrate the trade-off along an efficiency frontier that accounts for all combinations of medical and monetary goals. Coming from a solution that optimizes monetary costs, a significant reduction of expected mortality can be achieved at little additional monetary cost.
重症监护病房（ICU）是医疗系统中最重要和最昂贵的资源之一。尽管高昂的固定成本通常导致容量紧张，但资源短缺会带来严重的后果。因此，存在各种具有挑战性的问题：一般来说，ICU 应该接收还是拒绝到达的患者？ICU 是否应该始终能够接收重症患者，还是应该更注重高利用率？在运营层面上，到达患者的入院控制和当前住院患者的需求驱动提前出院都是决策变量，应同时考虑。本文通过将问题建模为马尔可夫决策过程，讨论了管理重症监护病房时医疗和货币目标之间的权衡。应用直观的、模仿实践中决策的短视规则作为基准。在基于实际数据的数值研究中，我们表明，仅关注货币目标会导致医疗结果急剧恶化，反之亦然。通过使用我们的模型，我们沿着一个效率前沿展示了权衡，该前沿考虑了所有医疗和货币目标的组合。从优化货币成本的解决方案出发，可以在几乎不增加货币成本的情况下，显著降低预期死亡率。
