Multiobjective Optimization in Health Care Management. A metaheuristic and simulation approach.

This paper describes a methodology which combines elements of statistics, probability, mathematical programming, simulation, multiobjective optimization and metaheuristics, to analyze management problems in a health care context. We apply this approach to a staffing problem in a primary care center, taking into account both cost and service quality criteria. We illustrate our approach with a case study

MULTIPLE-OBJECTIVE DECISION MAKING FOR AGROECOSYSTEM MANAGEMENT

Multiple-objective decision making (MODEM) provides an effective framework for integrated resource assessment of agroecosystems. Two elements of integrated assessment are discussed and illustrated: (1) adding noneconomic objectives as constraints in an optimization problem; and (2) evaluating tradeoffs among competing objectives using the efficiency frontier for objectives. These elements are illustrated for a crop farm and watershed in northern Missouri. An interactive, spatial decision support system (ISDSS) makes the MODEM framework accessible to unsophisticated users. A conceptual ISDSS is presented that assesses the socioeconomic, environmental, and ecological consequences of alternative management plans for reducing soil erosion and nonpoint source pollution in agroecosystems. A watershed decision support system based on the ISDSS is discussed.Agribusiness,

A derivative-free approach for a simulation-based optimization problem in healthcare

Hospitals have been challenged in recent years to deliver high quality care with limited resources. Given the pressure to contain costs,developing procedures for optimal resource allocation becomes more and more critical in this context. Indeed, under/overutilization of emergency room and ward resources can either compromise a hospital's ability to provide the best possible care, or result in precious funding going toward underutilized resources. Simulation--based optimization tools then help facilitating the planning and management of hospital services, by maximizing/minimizing some specific indices (e.g. net profit) subject to given clinical and economical constraints. In this work, we develop a simulation--based optimization approach for the resource planning of a specific hospital ward. At each step, we first consider a suitably chosen resource setting and evaluate both efficiency and satisfaction of the restrictions by means of a discrete--event simulation model. Then, taking into account the information obtained by the simulation process, we use a derivative--free optimization algorithm to modify the given setting. We report results for a real--world problem coming from the obstetrics ward of an Italian hospital showing both the effectiveness and the efficiency of the proposed approach

Integrating Multiobjective Optimization With The Six Sigma Methodology For Online Process Control

Over the past two decades, the Define-Measure-Analyze-Improve-Control (DMAIC) framework of the Six Sigma methodology and a host of statistical tools have been brought to bear on process improvement efforts in today’s businesses. However, a major challenge of implementing the Six Sigma methodology is maintaining the process improvements and providing real-time performance feedback and control after solutions are implemented, especially in the presence of multiple process performance objectives. The consideration of a multiplicity of objectives in business and process improvement is commonplace and, quite frankly, necessary. However, balancing the collection of objectives is challenging as the objectives are inextricably linked, and, oftentimes, in conflict. Previous studies have reported varied success in enhancing the Six Sigma methodology by integrating optimization methods in order to reduce variability. These studies focus these enhancements primarily within the Improve phase of the Six Sigma methodology, optimizing a single objective. The current research and practice of using the Six Sigma methodology and optimization methods do little to address the real-time feedback and control for online process control in the case of multiple objectives. This research proposes an innovative integrated Six Sigma multiobjective optimization (SSMO) approach for online process control. It integrates the Six Sigma DMAIC framework with a nature-inspired optimization procedure that iteratively perturbs a set of decision variables providing feedback to the online process, eventually converging to a set of tradeoff process configurations that improves and maintains process stability. For proof of concept, the approach is applied to a general business process model – a well-known inventory management model – that is formally defined and specifies various process costs as objective functions. The proposed iv SSMO approach and the business process model are programmed and incorporated into a software platform. Computational experiments are performed using both three sigma (3σ)-based and six sigma (6σ)-based process control, and the results reveal that the proposed SSMO approach performs far better than the traditional approaches in improving the stability of the process. This research investigation shows that the benefits of enhancing the Six Sigma method for multiobjective optimization and for online process control are immense

Disease diagnosis in smart healthcare: Innovation, technologies and applications

To promote sustainable development, the smart city implies a global vision that merges artificial intelligence, big data, decision making, information and communication technology (ICT), and the internet-of-things (IoT). The ageing issue is an aspect that researchers, companies and government should devote efforts in developing smart healthcare innovative technology and applications. In this paper, the topic of disease diagnosis in smart healthcare is reviewed. Typical emerging optimization algorithms and machine learning algorithms are summarized. Evolutionary optimization, stochastic optimization and combinatorial optimization are covered. Owning to the fact that there are plenty of applications in healthcare, four applications in the field of diseases diagnosis (which also list in the top 10 causes of global death in 2015), namely cardiovascular diseases, diabetes mellitus, Alzheimer’s disease and other forms of dementia, and tuberculosis, are considered. In addition, challenges in the deployment of disease diagnosis in healthcare have been discussed

Agent based simulation to optimise emergency departments

Nowadays, many of the health care systems are large and complex environments and quite dynamic, specifically Emergency Departments, EDs. It is opened and working 24 hours per day throughout the year with limited resources, whereas it is overcrowded. Thus, is mandatory to simulate EDs to improve qualitatively and quantitatively their performance. This improvement can be achieved modelling and simulating EDs using Agent-Based Model, ABM and optimising many different staff scenarios. This work optimises the staff configuration of an ED. In order to do optimisation, objective functions to minimise or maximise have to be set. One of those objective functions is to find the best or optimum staff configuration that minimise patient waiting time. The staff configuration comprises: doctors, triage nurses, and admissions, the amount and sort of them. Staff configuration is a combinatorial problem, that can take a lot of time to be solved. HPC is used to run the experiments, and encouraging results were obtained. However, even with the basic ED used in this work the search space is very large, thus, when the problem size increases, it is going to need more resources of processing in order to obtain results in an acceptable time

A Simulation--Based Optimization approach for analyzing the ambulance diversion phenomenon in an Emergency-Department network

Ambulance Diversion (AD) is one of the possible strategies for relieving the worldwide phenomenon of Emergency Department (ED) overcrowding. It can be carried out when an ED is overloaded and consists of redirecting incoming by ambulance patients to neighboring EDs. Properly implemented, AD should result in reducing delays of patient treatment, ensuring safety and rescue of life-threatening patients. From an operational point of view, AD corresponds to a resource pooling policy among EDs in a network. In this paper we propose a novel model for studying the effectiveness of AD strategies, based on the Simulation-Based Optimization (SBO) approach. In particular, we developed a discrete event simulation model for reproducing the ED network operation. Then, for each AD policy considered, we formulate and solve an optimal resources allocation problem consisting of a bi-objective SBO problem where the target is the minimization of the non-value added time spent by patients and the overall cost incurred by the ED network. A set of optimal points belonging to the Pareto frontier is obtained for each policy. To show the reliability of the proposed approach, a real case study consisting of six large EDs in the Lazio region of Italy is considered, analyzing the effects of adopting different AD policies.Comment: 22 page

Mathematics in health care with applications

The Author aims to show how mathematics can be useful in supporting key activities in a hospital, including: noninvasive measurement of a patient’s status (see chapter 1), evaluation of quality of services (see chapter 2), business and clinical administration (see chapter 3), and diagnosis and prognosis (see chapter 4). Such applications suggest the development of innovative projects to improve health care processes, services and systems. In this way, mathematics can be a very important tool for technological and societal development

Simulation Optimization for Healthcare Emergency Departments

AbstractThis article presents an Agent-Based modeling (ABM) simulation to design a decision support system (DSS) for Healthcare Emergency Department (ED). This DSS aims to aid EDs heads in setting up management guidelines to improve the operation of EDs. This ongoing research is being performed by the Research Group in Individual Oriented Modeling (IoM) at the University Autonoma of Barcelona (UAB) with close collaboration of Hospital ED Staff Team. The objective of the proposed ABM procedure is to optimize the performance of such complex and dynamic Healthcare EDs, because worldwide most of them are overcrowded, and unable to provide ad hoc care, quality and service. Exhaustive search (ES) optimization is used to find out the optimal ED staff configuration, which includes doctors, triage nurses, and admission personnel, i.e., a multidimensional problem. An index is proposed to minimize patient length of stay in the ED. The results obtained by using an alternative pipeline scheme to ES are promising and a better understanding of the problem is achieved. The impact of the pipeline scheme to reduce the computational cost of exhaustive search is outlined

Solving Combinatorial Optimization Problems Using Genetic Algorithms and Ant Colony Optimization

This dissertation presents metaheuristic approaches in the areas of genetic algorithms and ant colony optimization to combinatorial optimization problems. Ant colony optimization for the split delivery vehicle routing problem An Ant Colony Optimization (ACO) based approach is presented to solve the Split Delivery Vehicle Routing Problem (SDVRP). SDVRP is a relaxation of the Capacitated Vehicle Routing Problem (CVRP) wherein a customer can be visited by more than one vehicle. The proposed ACO based algorithm is tested on benchmark problems previously published in the literature. The results indicate that the ACO based approach is competitive in both solution quality and solution time. In some instances, the ACO method achieves the best known results to date for the benchmark problems. Hybrid genetic algorithm for the split delivery vehicle routing problem (SDVRP) The Vehicle Routing Problem (VRP) is a combinatory optimization problem in the field of transportation and logistics. There are various variants of VRP which have been developed of the years; one of which is the Split Delivery Vehicle Routing Problem (SDVRP). The SDVRP allows customers to be assigned to multiple routes. A hybrid genetic algorithm comprising a combination of ant colony optimization, genetic algorithm, and heuristics is proposed and tested on benchmark SDVRP test problems. Genetic algorithm approach to solve the hospital physician scheduling problem Emergency departments have repeating 24-hour cycles of non-stationary Poisson arrivals and high levels of service time variation. The problem is to find a shift schedule that considers queuing effects and minimizes average patient waiting time and maximizes physicians’ shift preference subject to constraints on shift start times, shift durations and total physician hours available per day. An approach that utilizes a genetic algorithm and discrete event simulation to solve the physician scheduling problem in a hospital is proposed. The approach is tested on real world datasets for physician schedules