考虑患者止步行为的动态入院接收决策模型

Dynamic Admission Decision Model Considering Patient Balking Behavior

大型公立医院病床供需矛盾日益突出,医院作为服务系统有必要考虑由于病床需求响应速度不及时而引起的患者策略性行为。针对患者到达时间的随机性与住院时长的不确定性,本文提出考虑患者止步行为的动态入院接收决策问题,制定了适用于可等待慢性病患者的入院接收决策方法,旨在提高患者的就医满意度,有效权衡多类患者的接收数量,降低由于科室响应速度过慢引发的患者止步频率。首先,本文对考虑患者止步行为的动态入院接收决策问题进行数学描述及符号定义;然后,对患者止步行为的影响因素进行分析并构建止步概率函数;进一步地,构建考虑患者止步行为的动态入院接收马尔可夫决策过程(MDP)模型,并针对模型特点设计值迭代算法,最后通过数值算例验证本文所提方法的可行性与有效性。

The contradiction between supply and demand of beds in large public hospitals is increasingly prominent.As a service system,it is necessary for hospitals to consider the patient’s strategic behavior caused by untimely response speed of the hospital bed demand.In this paper,a dynamic admission decision problem considering patient balking behavior is proposed,and an admission decision method suitable for waiting patients with chronic diseases is developed.The purpose is to improve the patients’satisfaction,and effectively weigh the number of multiple patients received,and reduce the frequency of patient balking behavior caused by the slow response speed in the department.Firstly,this paper gives the mathematical description of the dynamic admission decision problem considering balking behavior and defines the symbol.Then we analyze the influence factors of the patient balking behavior and construct the balking probability function.Further,we establish the Markov decision process(MDP)model of the dynamic admission decision considering patient balking behavior and design value iteration algorithm to solve it according to the characteristics of this model.Finally,we design a numerical example to verify the feasibility and effectiveness of the method.