论文标题
COVID-19的压力下的医疗保健系统的最佳资源和需求重新分配
Optimal Resource and Demand Redistribution for Healthcare Systems Under Stress from COVID-19
论文作者
论文摘要
当面对极端压力源(例如Covid-19大流行)时,医疗保健系统通常会通过在设施或接近其基线容量的设施中产生激增的能力来反应反应。但是,在每个设施中建立个人容量不一定是最佳方法,重新分配需求和设施之间的关键资源可以降低所需的总能力。数据表明,这种额外的负载是在Covid-19大流行期间在医院之间分配不均的,要求一些人在附近的医院没有使用的能力时产生涌现能力。不仅这种效率低下,而且还可能导致产能过度的医院的护理质量下降。在这项工作中,我们研究了寻找最佳需求和资源转移的问题,以最大程度地减少需求增长期间所需的激增能力和资源短缺。我们开发和分析了一系列线性和混合组件编程模型,以解决需求和资源再分配问题的变体。我们还考虑要求不确定性并使用强大的优化来确保解决方案可行性。我们还结合了决策者在实施此类计划时可能需要考虑的一系列运营限制和成本。我们的模型使用来自新泽西州,德克萨斯州和迈阿密的CoVID-19的住院数据进行了回顾性验证,相对于每种情况的观察到的结果,所需的激增能力至少降低了85%。结果表明,这种解决方案在操作上是可行的,并且在需求不确定性方面足够健壮。总而言之,这项工作为医疗保健系统中的决策者提供了一种实用且灵活的工具,以降低某些设施超过容量的情况下适当护理患者所需的激增能力。
When facing an extreme stressor, such as the COVID-19 pandemic, healthcare systems typically respond reactively by creating surge capacity at facilities that are at or approaching their baseline capacity. However, creating individual capacity at each facility is not necessarily the optimal approach, and redistributing demand and critical resources between facilities can reduce the total required capacity. Data shows that this additional load was unevenly distributed between hospitals during the COVID-19 pandemic, requiring some to create surge capacity while nearby hospitals had unused capacity. Not only is this inefficient, but it also could lead to a decreased quality of care at over-capacity hospitals. In this work, we study the problem of finding optimal demand and resource transfers to minimize the required surge capacity and resource shortage during a period of heightened demand. We develop and analyze a series of linear and mixed-integer programming models that solve variants of the demand and resource redistribution problem. We additionally consider demand uncertainty and use robust optimization to ensure solution feasibility. We also incorporate a range of operational constraints and costs that decision-makers may need to consider when implementing such a scheme. Our models are validated retrospectively using COVID-19 hospitalization data from New Jersey, Texas, and Miami, yielding at least an 85% reduction in required surge capacity relative to the observed outcome of each case. Results show that such solutions are operationally feasible and sufficiently robust against demand uncertainty. In summary, this work provides decision-makers in healthcare systems with a practical and flexible tool to reduce the surge capacity necessary to properly care for patients in cases when some facilities are over capacity.