Predicting patient risk of readmission with frailty models in the Department of Veteran Affairs

Reducing potentially preventable readmissions has been identified as an important issue for decreasing Medicare costs and improving quality of care provided by hospitals. Based on previous research by medical professionals, preventable readmissions are caused by such factors as flawed patient discharging process, inadequate follow-ups after discharging, and noncompliance of patients on discharging and follow up instructions. It is also found that the risk of preventable readmission also may relate to some patient's characteristics, such as age, health condition, diagnosis, and even treatment specialty. In this study, using both general demographic information and individual past history of readmission records, we develop a risk prediction model based on hierarchical nonlinear mixed effect framework to extract significant prognostic factors associated with patient risk of 30-day readmission. The effectiveness of our proposed approach is validated based on a real dataset from four VA facilities in the State of Michigan. Simultaneously explaining both patient and population based variations of readmission process, such an accurate model can be used to recognize patients with high likelihood of discharging non-compliances, and then targeted post-care actions can be designed to reduce further rehospitalization.Comment: 6 pages, to be submitted in IEEE CASE 201

Modelling activities at a neurological rehabilitation unit

A queuing model is developed for the neurological rehabilitation unit at Rookwood Hospital in Cardiff. Arrivals at the queuing system are represented by patient referrals and service is represented by patient length of stay (typically five months). Since there are often delays to discharge, length of stay is partitioned into two parts: admission until date ready for discharge (modelled by Coxian phase-type distribution) and date ready for discharge until ultimate discharge (modelled by exponential distribution). The attributes of patients (such as age, gender, diagnosis etc) are taken into account since they affect these distributions. A computer program has been developed to solve this multi-server (21 bed) queuing system to produce steady-state probabilities and various performance measures. However, early on in the project it became apparent that the intensity of treatment received by patients has an effect on the time, from admission, until they are ready for discharge. That is, the service rates of the Coxian distribution are dependent on the amount of therapy received over time. This directly relates to the amount of treatment allocated in the weekly timetables. For the physiotherapy department, these take about eight hours to produce each week by hand. In order to ask the valuable what-if questions that relate to treatment intensity, it is therefore necessary to produce an automated scheduling program that replicates the manual assignment of therapy. The quality of timetables produced using this program was, in fact, considerably better than its alternative and so replaced the by-hand approach. Other benefits are more clinical time (since less employee input is required)and a convenient output of data and performance measures that are required for audit purposes. Once the model is constructed a number of relevant hypothetical scenarios are considered. Such as, what if delays to discharge are reduced by 50%? Also, through the scheduling program, the effect of changes to the composition of staff or therapy sessions can be evaluated, for example, what if the number of therapists is increased by one third? The effects of such measures are analysed by studying performance measures (such as throughput and occupancy) and the associated costs

Determining readmission time window using mixture of generalised Erlang distribution

Erin Demir, et al, 'Determining Readmission Time Window Using Mixture of Generalised Erlang Distribution', in Proceedings of the 20th IEEE International Symposium on Computer-Based Medical Systems, June 2007, doi: https://doi.org/10.1109/CBMS.2007.39.The absence of a unified definition of readmissions has motivated the development of a modelling approach, to systematically tackle the issue surrounding the appropriate choice of a time window which defines readmission. The population of discharged patients can be broadly divided in two groups - a group at high risk of readmission and a group at low risk. This approach extends previous work by the authors, without restricting the number of stages, that patients may experience in the community. Using the national data (UK), we demonstrate its usefulness in the case of chronic obstructive pulmonary disease (COPD) which is known to be one of the leading causes of readmission. We further investigate variability in the definition of readmission among 10 strategic health authorities (SHAs) in England and observe that there are differences in the estimated time window across SHAs. The novelty of this modelling approach is the ability of capturing time to readmission that exhibit a non-zero mode and to estimate an appropriate time window based on evidence objectively derived from operational data

Safety and Reliability - Safe Societies in a Changing World

The contributions cover a wide range of methodologies and application areas for safety and reliability that contribute to safe societies in a changing world. These methodologies and applications include: - foundations of risk and reliability assessment and management - mathematical methods in reliability and safety - risk assessment - risk management - system reliability - uncertainty analysis - digitalization and big data - prognostics and system health management - occupational safety - accident and incident modeling - maintenance modeling and applications - simulation for safety and reliability analysis - dynamic risk and barrier management - organizational factors and safety culture - human factors and human reliability - resilience engineering - structural reliability - natural hazards - security - economic analysis in risk managemen

Fuelling the zero-emissions road freight of the future: routing of mobile fuellers

The future of zero-emissions road freight is closely tied to the sufficient availability of new and clean fuel options such as electricity and Hydrogen. In goods distribution using Electric Commercial Vehicles (ECVs) and Hydrogen Fuel Cell Vehicles (HFCVs) a major challenge in the transition period would pertain to their limited autonomy and scarce and unevenly distributed refuelling stations. One viable solution to facilitate and speed up the adoption of ECVs/HFCVs by logistics, however, is to get the fuel to the point where it is needed (instead of diverting the route of delivery vehicles to refuelling stations) using "Mobile Fuellers (MFs)". These are mobile battery swapping/recharging vans or mobile Hydrogen fuellers that can travel to a running ECV/HFCV to provide the fuel they require to complete their delivery routes at a rendezvous time and space. In this presentation, new vehicle routing models will be presented for a third party company that provides MF services. In the proposed problem variant, the MF provider company receives routing plans of multiple customer companies and has to design routes for a fleet of capacitated MFs that have to synchronise their routes with the running vehicles to deliver the required amount of fuel on-the-fly. This presentation will discuss and compare several mathematical models based on different business models and collaborative logistics scenarios