Modeling hospital infrastructure by optimizing quality, accessibility and efficiency via a mixed integer programming model
Ikkersheim,David Tanke,Marit Van Schooten,Gwendy De Bresser,Niels Fleuren,H.A.
Ikkersheim,David
Tanke,Marit
Van Schooten,Gwendy
De Bresser,Niels
Fleuren,H.A.
Abstract
Background: The majority of curative health care is organized in hospitals. As in most other countries, the current 94 hospital locations in the Netherlands offer almost all treatments, ranging from rather basic to very complex care. Recent studies show that concentration of care can lead to substantial quality improvements for complex conditions and that dispersion of care for chronic conditions may increase quality of care. In previous studies on allocation of hospital infrastructure, the allocation is usually only based on accessibility and/or efficiency of hospital care. In this paper, we explore the possibilities to include a quality function in the objective function, to give global directions to how the 'optimal' hospital infrastructure would be in the Dutch context. Methods. To create optimal societal value we have used a mathematical mixed integer programming (MIP) model that balances quality, efficiency and accessibility of care for 30 ICD-9 diagnosis groups. Typical aspects that are taken into account are the volume-outcome relationship, the maximum accepted travel times for diagnosis groups that may need emergency treatment and the minimum use of facilities. Results: The optimal number of hospital locations per diagnosis group varies from 12-14 locations for diagnosis groups which have a strong volume-outcome relationship, such as neoplasms, to 150 locations for chronic diagnosis groups such as diabetes and chronic obstructive pulmonary disease (COPD). Conclusions: In conclusion, our study shows a new approach for allocating hospital infrastructure over a country or certain region that includes quality of care in relation to volume per provider that can be used in various countries or regions. In addition, our model shows that within the Dutch context chronic care may be too concentrated and complex and/or acute care may be too dispersed. Our approach can relatively easily be adopted towards other countries or regions and is very suitable to perform a 'what-if' analysis.
Description
Date
2013
Journal Title
Journal ISSN
Volume Title
Publisher
Research Projects
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Journal Issue
Keywords
SDG 3 - Good Health and Well-being
Citation
Ikkersheim, D, Tanke, M, Van Schooten, G, De Bresser, N & Fleuren, H A 2013, 'Modeling hospital infrastructure by optimizing quality, accessibility and efficiency via a mixed integer programming model', BMC Health Services Research, vol. 13, 220. https://doi.org/10.1186/1472-6963-13-220
License
info:eu-repo/semantics/openAccess