论文标题
带有回报的服务系统的动态控制:申请设计后出院后医院再入院计划
Dynamic Control of Service Systems with Returns: Application to Design of Post-Discharge Hospital Readmission Prevention Programs
论文作者
论文摘要
我们研究了排队系统的控制问题,客户在最初的服务完成后可能会返回其他服务。在每个服务完成时期,决策者可以选择降低离职客户回报的可能性,但以凸率增加的回报概率减少量增加。当客户在队列中等待以及每次返回服务时,其他费用会产生。我们的主要动机来自放电后质量改进(QI)干预措施(例如,跟进电话通话,预约)在各种医疗保健环境中经常使用,以减少计划外的医院再入院。我们的目标是了解应如何平衡交通拥堵和服务成本的干预成本。为此,我们考虑了排队系统的流体近似,并表征了流体模型最佳的长期平均平均值和偏置最佳瞬态控制策略的结构。我们的结构结果激发了直观激增协议的设计,从而根据系统的拥塞提供了不同的干预强度(对应于回报概率的不同级别)。通过广泛的模拟实验,我们研究了随机系统的流体策略的性能,并确定参数制度与固定的长期长期平均最佳政策相比,它可以在其中节省大量成本,而固定的长期平均最佳政策忽略了持有成本和使用最高干预措施的简单政策,只要排队不空。特别是,我们发现,在与我们激励的应用相关的参数制度中,与简单的积极政策相比,长期平均成本的动态调整可能会导致长期平均成本降低高达25.4%,有限 - 霍利为有限 - 霍森的成本33.7%。
We study a control problem for queueing systems where customers may return for additional episodes of service after their initial service completion. At each service completion epoch, the decision maker can choose to reduce the probability of return for the departing customer but at a cost that is convex increasing in the amount of reduction in the return probability. Other costs are incurred as customers wait in the queue and every time they return for service. Our primary motivation comes from post-discharge Quality Improvement (QI) interventions (e.g., follow up phone-calls, appointments) frequently used in a variety of healthcare settings to reduce unplanned hospital readmissions. Our objective is to understand how the cost of interventions should be balanced with the reductions in congestion and service costs. To this end, we consider a fluid approximation of the queueing system and characterize the structure of optimal long-run average and bias-optimal transient control policies for the fluid model. Our structural results motivate the design of intuitive surge protocols whereby different intensities of interventions (corresponding to different levels of reduction in the return probability) are provided based on the congestion in the system. Through extensive simulation experiments, we study the performance of the fluid policy for the stochastic system and identify parameter regimes where it leads to significant cost savings compared to a fixed long-run average optimal policy that ignores holding costs and a simple policy that uses the highest level of intervention whenever the queue is non-empty. In particular, we find that in a parameter regime relevant to our motivating application, dynamically adjusting the intensity of interventions could result in up to 25.4% reduction in long-run average cost and 33.7% in finite-horizon costs compared to the simple aggressive policy.