In recent years, increasing availability of data and advances in predictive analytics present new opportunities and challenges to healthcare management. Predictive models are developed to evaluate various aspects of healthcare systems, such as patient demand, patient pathways, and patient outcomes. While these predictions potentially provide valuable information to improve healthcare delivery, there are still many open questions considering how to integrate these forecasts into operational decisions. In this context, this dissertation develops methodologies to combine predictive analytics with the design of healthcare delivery systems.
The first part of dissertation considers how to schedule proactive care in the presence of patient deterioration. Healthcare systems are typically limited resource environments where scarce capacity is reserved for the most urgent patients. However, there has been a growing interest in the use of proactive care when a less urgent patient is predicted to become urgent while waiting. On one hand, providing care for patients when they are less critical could mean that fewer resources are needed to fulfill their treatment requirement. On the other hand, due to prediction errors, the moderate patients who are predicted to deteriorate in the future may self cure on their own and never need the treatment. Hence, allocating limited resource for these patients takes the capacity away from other more urgent ones who need it now. To understand this tension, we propose a multi-server queueing model with two patient classes: moderate and urgent. We allow patients to transition classes while waiting. In this setting, we characterize how moderate and urgent patients should be prioritized for treatment when proactive care for moderate patients is an option.
The second part of the dissertation focuses on the nurse staffing decisions in the emergency departments (ED). Optimizing ED nurse staffing decisions to balance the quality of service and staffing cost can be extremely challenging, especially when there is a high level of uncertainty in patient demand. Increasing data availability and continuing advancements in predictive analytics provide an opportunity to mitigate demand uncertainty by utilizing demand forecasts. In the second part of the dissertation, we study a two-stage prediction-driven staffing framework where the prediction models are integrated with the base (made weeks in advance) and surge (made nearly real-time) staffing decisions in the ED. We quantify the benefit of having the ability to use the more expensive surge staffing. We also propose a near-optimal two-stage staffing policy that is straightforward to interpret and implement. Lastly, we develop a unified framework that combines parameter estimation, real-time demand forecasts, and capacity sizing in the ED. High-fidelity simulation experiments for the ED demonstrate that the proposed framework can reduce annual staffing costs by 11%-16% ($2 M-$3 M) while guaranteeing timely access to care.
| Identifer | oai:union.ndltd.org:columbia.edu/oai:academiccommons.columbia.edu:10.7916/8xx6-gb07 |
| Date | January 2022 |
| Creators | Hu, Yue |
| Source Sets | Columbia University |
| Language | English |
| Detected Language | English |
| Type | Theses |
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