考虑患者不守时的个性化随访策略设计  

Design of Personalized Follow-up Policies Considering Patient Unpunctuality

作　　者：李玫 刘子先[2] 赵衡 梁丽军 LI Mei;LIU Zixian;ZHAO Heng;LIANG Lijun(School of Management,Xi'an University of Architecture and Technology,Xi'an,Shaanxi 710055,China;College of Management and Economics,Tianjin University,Tianjin 300072,China;School of Management,Tianjin University of Technology,Tianjin 300084,China;School of Management,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]西安建筑科技大学管理学院,陕西西安710055 [2]天津大学管理与经济学部,天津300072 [3]天津理工大学管理学院,天津300084 [4]天津中医药大学管理学院,天津301617

出　　处：《工业工程与管理》2024年第4期42-53,共12页Industrial Engineering and Management

基　　金：国家自然科学基金资助项目(71871158,72104180)。

摘　　要：恰当的随访策略对于预防不良后果、控制医疗服务成本具有重要意义。现有研究采用马尔可夫模型、数学规划等运筹学方法设计随访策略,缺乏对患者不守时随访行为的考虑,所得策略无法满足不同患者的差异化需求。本文利用Cox-Frailty模型构建不良后果风险函数,并将患者分为不同风险组别;引入一组独立同分布的随机变量对策略规定的随访时间和患者实际的随访时间的差值进行建模;结合virtual age和随机过程方法精准核算计划时间区间的医疗服务成本,并构建以该成本最小为目标函数的混合整数非线性规划模型。利用所提模型得到不同风险水平的儿童1型糖尿病患者在1年内的最优随访次数和随访时间间隔,以及患者守时和不守时情况下的策略变化规律,从而为医疗机构进行策略动态调整提供依据。Suitable follow-up policies are critical for avoiding complications and controlling medical service costs.Follow-up policies are designed based on operations research methods in the existing literature,such as Markov models and mathematical programming,which lack consideration of patients'unpunctual follow-up behavior,and the resulting policies cannot meet the needs of different patients.The Cox-Frailty model was employed to construct the risk function of adverse outcomes and stratify patients into several risk groups.The timing deviations between each follow-up that a policy scheduled and the one that a patient actually has were modeled by a set of independent and identically distributed random variables.At last,the medical service cost during the planning horizon was computed using the combined methods of virtual age and stochastic process,which was then minimized by a mixed integer nonlinear programming model.Based on the proposed model,the optimal frequency and time interval of follow-ups considering unpunctuality for pediatric TiDM patients with different risks during 1 year were derived and compared with their punctual counterparts,which formed the basis for hospitals to dynamicallyadjustpolicies.

关 键 词：随访策略 患者不守时 个性化 患者异质性 

分 类 号：C935[经济管理—管理学] R19[医药卫生—卫生事业管理]