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浙江大学学报(工学版)  2021, Vol. 55 Issue (7): 1261-1269    DOI: 10.3785/j.issn.1008-973X.2021.07.005
计算机与控制工程     
考虑医疗质量差异的医院转诊决策优化
王伟(),李娜*()
上海交通大学 机械与动力工程学院,上海 200240
Optimization of referral decision considering differences in medical quality
Wei WANG(),Na LI*()
School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
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摘要:

为了解决目前医联体中的转诊不当造成的拥堵问题,针对三级医院和社区医院组成的医疗系统,考虑病人流的转移过程,进行排队网络建模. 设计基于堵塞时长的迭代算法求解稳态性能参数,建立三级医院的决策优化模型,通过内点法求得最优转诊比例. 实验结果表明,优先转诊的病人具有治疗费用低、住院时间长的特点;当医疗质量差异存在时,需要通过优化分析降低病人回流造成的资源浪费.

关键词: 医疗转诊排队论迭代算法马尔可夫链医疗质量    
Abstract:

A queuing network model was carried out considering the patients’ transfer process, in order to solve the congestion problem caused by improper referral in the current medical consortium, for the medical system composed of a tertiary hospital and community hospitals. Based on the blocktime in the system, an iterative algorithm was designed to solve the steady-state performance parameters, the optimization model of the tertiary hospital was established, the optimal referral ratio was obtained through the interior point method. Experiment results show that transferred patients have the characteristics of low treatment cost and long hospital stay; when there are differences in medical quality, optimization analysis is needed to reduce the waste of resources caused by patient return.

Key words: medical referral    queuing theory    iterative algorithm    Markov chain    medical quality
收稿日期: 2020-03-02 出版日期: 2021-07-05
CLC:  C 935  
基金资助: 国家自然科学基金资助项目(71871138,71471114)
通讯作者: 李娜     E-mail: 1245862284@sjtu.edu.cn;na-li03@sjtu.edu.cn
作者简介: 王伟(1996—),男,硕士生,从事排队论、医疗服务系统研究. orcid.org/0000-0003-2539-941X. E-mail: 1245862284@sjtu.edu.cn
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引用本文:

王伟,李娜. 考虑医疗质量差异的医院转诊决策优化[J]. 浙江大学学报(工学版), 2021, 55(7): 1261-1269.

Wei WANG,Na LI. Optimization of referral decision considering differences in medical quality. Journal of ZheJiang University (Engineering Science), 2021, 55(7): 1261-1269.

链接本文:

https://www.zjujournals.com/eng/CN/10.3785/j.issn.1008-973X.2021.07.005        https://www.zjujournals.com/eng/CN/Y2021/V55/I7/1261

图 1  病人流的排队网络模型图
图 2  服务后堵塞现象模型图
图 3  三级医院排队子系统模型图
图 4  社区医院排队系统模型图
图 5  社区医院马尔可夫状态转移图
$ {b}_{\mathrm{L}} $/张 $ {T}_{\mathrm{B}} $/d $ {P}^{\mathrm{H}} $ $ \;{\rho }_{\mathrm{L}} $ 相对误差/%
仿真 本文算法 仿真 本文算法 仿真 本文算法 ${T}_{\mathrm{B}} $ $ {P}^{\mathrm{H}} $ $ \;{\rho }_{\mathrm{L}} $
14 2.608 2.590 0.149 0.148 0.855 0.853 0.68 0.91 0.19
16 0.569 0.565 0.142 0.140 0.748 0.748 0.66 1.18 0.00
18 0.139 0.140 0.138 0.139 0.666 0.666 0.70 0.51 0.03
20 0.034 0.033 0.138 0.138 0.599 0.599 0.86 0.15 0.01
表 1  仿真与本文算法的参数
主诊断 病例占比/% 住院天数/d 住院费用/元
治疗床位 康复床位 治疗床位 康复床位
股骨颈骨折 9.95 6 13 48427 7264
胫腓骨干骨折 1.32 4 10 50462 7821
跖骨骨折 1.01 6 11 28875 8004
股骨粗隆间骨折 7.09 7 10 38413 7277
跟骨骨折 3.92 9 12 35987 6932
闭合性胫骨平台骨折 3.44 7 12 62132 7417
髌骨骨折 2.54 6 15 18483 6947
胫腓骨下端骨折 2.49 5 11 52246 5945
胫骨骨折 1.11 6 12 39437 6426
$ \vdots$ $ \vdots$ $ \vdots$ $ \vdots$ $ \vdots$ $ \vdots$
表 2  三级医院适合转诊的部分疾病相关参数
序号 bL/张 qt/% $ {p}_{{\rm{a}}} $/% $ {p}_{{\rm{b}}} $/% $ {W}_{\mathrm{H}} $/元
1 $ \infty $ $ 0 $ 22.15 100.00 115221.72
2 $ 20$ $ 0 $ 0.01 55.62 102486.49
3 $ 20 $ $1$ 0.00 55.59 102501.10
4 $ 20$ $ 3$ 0.00 55.48 102510.14
5 $ 20 $ $5 $ 0.00 55.33 102492.87
6 $ 20 $ $ 10 $ 0.00 54.83 102337.22
表 3  社区医院参数对最优转诊率的影响
$ {R}_{1a} $/元 $ {R}_{2a} $/元 $ {p}_{a} $/% $ {p}_{b} $/% $ {W}_{\mathrm{H}} $/元
20000.0 12996.84 0.00 53.06 84071.69
31093.2 12996.84 27.79 0.00 101537.32
50000.0 12996.84 24.22 0.00 131684.63
31093.2 9000.00 27.79 0.00 96250.17
31093.2 12996.84 0.00 55.33 102492.79
31093.2 15000.00 0.00 55.53 106141.80
表 4  疾病治疗费用对最优决策的影响
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