论文

Clinical Pathway Analysis using Process Mining and Predictive Modeling in Healthcare: an Application to Incisional Hernia


An incisional hernia (IH) is a ventral hernia that develops after surgical trauma to the abdominal wall, a laparotomy. IH repair is a common surgery that can generate chronic pain, decreased quality of life, and significant healthcare costs caused by hospital readmissions. The goal of this study is to analyze the clinical pathway of patients having an IH using a medico-administrative database and predictive modeling. Predictive modeling in healthcare is used, among other things, to understand the times of occurrence of complications and associated costs. It enables the simulation of what-if scenarios to propose an improved care pathway for patients who are the most exposed.

Assessment of the Impact of Teledermatology using Discrete Event Simulation


Evolution of technology and the complexity of the medical system have contributed to the increasing interest in telemedicine. The purpose of this paper is to present a discrete event simulation model of the teledermatology process using the tool TelDerm. The logic of the simulation describes the telemedicine work flow from the detection of the problem to its resolution. The scenarios reflect different changes in the flow in order to quantify the impact of telemedicine on the healthcare system. Several key performance indicators measure medical and administrative workload variations for all human resources involved. In addition, we assess the impact on the patient’s journey through the process.

A Hybrid Modelling Approach using Forecasting and Real-Time Simulation to Prevent Emergency Department Overcrowding


Emergency Room (Emergency Department) overcrowding is a pervasive problem worldwide, which impacts both performance and safety. Staff are required to react and adapt to changes in demand in real-time, while continuing to treat patients.

This paper employs a case study to propose a hybrid application of discrete-event simulation (DES) and time-series forecasting across multiple centers in an urgent care network as one of the emergency room overcrowding solutions. It uses seasonal ARIMA time-series forecasting to predict overcrowding in a near-future moving-window (1-4 hours) using data downloaded from a digital platform (NHSquicker). NHSquicker delivers real-time wait-times from multiple centers of urgent care in the South-West of England. Alongside historical distributions, this data loads the operational state of a real-time discrete-event simulation model at initialization.

Simulation of epidemic trends for a new coronavirus under effective control measures


In December 2019, there was a case of viral pneumonia in Wuhan. After confirming that the pathogen of this disease is a new coronavirus, the World Health Organization (WHO) confirmed and named it 2019-nCoV. The pneumonia caused by this pathogen infection is called a novel corona virus pneumonia.

To better understand the mode of transmission of 2019-nCoV among the population and the effects of control measures, the study was conducted using agent-based modeling (ABM) to simulate an interactive environment over a certain space-time range. The study simulates the trend of 2019-nCoV infection at different levels of close contact in order to provide relevant information and references.

A Simulation Model to Assess the Impact of Insurance Expansion on Colorectal Cancer Screening at the Population Level


Recent US healthcare reform debates have triggered substantial discussion on how best to improve access to insurance. Colorectal cancer (CRC) is an example of a largely preventable condition, if access to and use of healthcare is increased. Early and ongoing screening and intervention can identify and remove polyps before they become cancerous. We present the development of an individual-based discrete-event simulation model to estimate the impact of insurance expansion scenarios on CRC screening, incidence, mortality, and costs. A national repeated cross-sectional survey was used to estimate which individuals obtained insurance in North Carolina (NC) after the Affordable Care Act (ACA). The potential impact of expanding the state’s Medicaid program is tested and compared to no insurance reform and the ACA without Medicaid expansion. The model integrates a census-based synthetic population, national data, claims based statistical models, and a natural history module in which simulated polyps and cancer progress.

Building a Flexible Simulation Model for Modeling Multiple Outpatient Orthopedic Clinics


This study is designed to demonstrate the benefit of using a single simulation model in order to analyze operations at two distinct, but related, pediatric orthopedic outpatient clinics in Massachusetts. A simulation model with a built-in dashboard is constructed for the clinics using AnyLogic. The constructed simulation model has been proven to be a useful tool in anticipating the effects of changes in system features such as patient volume, provider team mix, and exam room assignment policies. With the development of a flexible simulation model the ultimate goal is to assist clinic managers in their efforts to reduce patient waiting time and lengths of stay in the two distinct orthopedic clinics.

A Simulation and Online Optimization Approach for the Real-time Management of Ambulances


Emergency Medical Service (EMS) is one of the most important health care services as it plays a vital role in saving people’s lives and reducing the rate of mortality and co-morbidity. The importance and sensitivity of decision making in the EMS field have been recognized by researchers who studied many problems arising in the management of EMS systems since the 1960. Some authors of similar research present a review of the many simulation models that have been developed over the years: most of the available simulation approaches are based on a Discrete Event Simulation (DES) approach.

Improving Quality of Care in a Multidisciplinary Emergency Department by the Use of Simulation Optimization: Preliminary Results


Emergency department (ED) crowding is a worldwide challenge. It adversely affects quality of care, patient safety, and employee satisfaction. The magnitude of ED crowding can be measured by the quality metrics length-of-stay (LOS), the patient’s door-to-doctor-time (DTD), and the 4-hourstandard. This standard states that 95% of the patients stay less than four hours within the ED. In order to improve those metrics, healthcare processes have to be welldesigned and resource capacity has to match the ever increasing demand. We implemented a validated, detailed discrete-event simulation model of a multidisciplinary ED in Germany to provide decision support for ED managers. Our model incorporates several patient flows considering patients and resources of two different medical specialties. The introduced simulation model was parameterized according to real-world data. Leveraging OptQuest and AnyLogic, we combined optimization and simulation to find input staffing levels that minimize the avg. LOS of patients. Simulation experiments show that certain process modifications, nurse pooling, and optimized staffing levels lead to improvements in quality of care. With respect to that, both avoiding boarding of inpatients and implementing nurse pooling result in a decrease of more than 14% in avg. LOS and are particularly promising. We also identified that reallocating capacities from internists to nurses dedicated to internal medicine patients enhances the quality of care.

A Hybrid Discrete Event Agent Based Overdue Pregnancy Outpatient Clinic Simulation Model


This paper provides an overview of a hybrid, discrete event simulation (DES) agent based model (ABM), simulation model of the overdue pregnancy outpatient clinic at the Obstetrics department of Akershus University Hospital, Norway. The model is being developed in collaboration with clinic staff. The purpose of the model is to better plan resources (e.g. staffing) to improve patient flow at the outpatient clinic given the uncertainty associated with demand. The uncertainty is due to an increase in the size of the hospital’s catchment area, changes to overdue pregnancy guidelines in Norway and that women can give birth before their appointments. The ABM model component represents the human parts of the system, the women and the clinic staff. The DES component represents the outpatient clinic’s physical location and processes/pathways that operate within it. The technicalities of the model are presented along with some illustrative results.

A Multi-method Scheduling Framework for Medical Staff


Hospital planning teams are always concerned with optimizing staffing and scheduling decisions in order to improve hospital performance, patient experience, and staff satisfaction. A multi-method approach including data analytics, modeling and simulation, machine learning, and optimization is proposed to provide a framework for smart and applicable solutions for staffing and shift scheduling. Factors regarding patients, staff, and hospitals are considered in the decision. This framework is piloted using the Emergency Department(ED) of a leading university hospital in Dublin.