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.
Wei WANG,Na LI. Optimization of referral decision considering differences in medical quality. Journal of ZheJiang University (Engineering Science), 2021, 55(7): 1261-1269.
Fig.1Queuing network model of diagram patient flow
Fig.2Congestion block-after service system model diagram
Fig.3Queuing subsystem in tertiary hospital
Fig.4Queuing system in community hospital
Fig.5Markov state transition diagram in community hospital
$ {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
Tab.1Parameters of simulation and proposed algorithm
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$
Tab.2Some disease-related parameters suitable for referral in central hospital
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
Tab.3Influence of community hospital parameters on optimal referral rate
$ {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
Tab.4Influence of disease treatment cost on optimal decision
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