Study On Optimization Of Community Healthcare Network Planning And Patient Flow Control In Urban Hierarchical Healthcare System

As a critical component in the urban healthcare service system with hierarchically distribution, community healthcare services provide primary healthcare service to local residents. Coordinating with general hospitals and network planning of community healthcare services play important roles on relieving current social sufferings caused by irrational healthcare resource allocation, expensive medical cost, and inconvenient service access. This study was targeted to strengthen the availability of healthcare services, the accessibility of healthcare services for patients, and the operational efficiency of health service facilities. To achieve the goals, optimization research on improving service quality was conducted from two aspects: the community health service network location in planning level and the patient flow control in operation level.Firstly, based on the operating characteristics of community healthcare service system, this study developed a method to estimate the healthcare demand of community residents with different demography features. In order to improve current irrational network planning of community health services and satisfy the residents'healthcare demands, a linear mathematical programming model was established to determine the optimal locations, facility numbers, service size and service categories in community healthcare service network. Examed by Haidian District in Beijing city, the model was proved effective on reducing the average medical cost of patients, raising the total number of cured patients, and enhancing the accessibility and availability of healthcare services for patients. Sensitivity analysis of parameters in the model was conducted thereafter, which offers the decision-makers an aid on selecting the best plan under their actual situations.Secondly, the coordination between community healthcare centers and general hospitals was considered in the patient flow control study. When registrating in general hospitals, the referred patients from community healthcare centers were given priorities compared to walk-in patients. This priority incentive will conduct the optimal patient flow in urban hierarchical healthcare system positively. The block queueing model with batch size service was developed to model current patient flow congestion in healthcare system. Along with the definition of"effective service time", the single node decomposition algorithm was propsed to solve the average waiting time and waiting length of patients. Result showed that patients'waiting time was effectively shortened by accelerating the referral patients'processing speed. Increasing the gap of waiting time in general hospitals between referral patients and regular walk-in patients will encourage more patients to select primary treatment in community health centers, and finally balance the utilization among different levels of healthcare facilities and enhance patients'accessibility to healthcare services.Finally, an Arena simulation model was established to simulate the patient flow in urban hierarchical healthcare system. Combining with the actual statistic of pantients'attendance in healthcare services in Haidian District, results from the simulation model suggested that the priority referral incentives can effectively reduce the waiting time for patients. The improved healthcare system will increase the total number of cured patients and enhance the operational efficiency of health care facilities.