Research On Patient Flow Modeling And Referral Strategy Optimization Based On Hierarchical Medical System

In order to promote a reasonable medical treatment order for patients,China has been devoted to the construction of a hierarchical medical system in recent years,of which referral is a key part.Efficient implementation of referral mechanism can promote the reasonable flow of patients among different levels of medical institutions and improve the service efficiency of the whole medical system.However,the current unclear status of referral mechanism and the non-standardized referral process have led to questions about how the referral process should be implemented to achieve the expected results.Current researches on patient referral mostly stay at the theoretical level,and the conclusions are difficult to implement in reality.Although there are a few quantitative studies,the scenarios and processes of patient referrals considered are too simple,and the models still have room for improvement.Under this background,this article studies the patient referral problem.The patient flow models under different referral scenarios are constructed according to the diagnosis and treatment processes of patients between different medical institutions.On this basis,the referral strategies are studied,and an example verification of patient's electronic referral process is conducted.First,the key elements in the operation of the referral mechanism are analyzed.The basic elements of referral,the characteristics of the patients,the classification of referral strategies,the specific process of patients' referral and the referral goals under different conditions are summarized,providing a systematic approach to the establishment and analysis of patient flow models under referral background.Second,patient flow models in referral scenarios under whole process of patient treatment are constructed.Patient flow models under outpatient and inpatient referral scenarios are constructed respectively on the basis of clarifying patient referral scenarios and referral process.Based on a fixed rate referral strategy,simulation method is used to model the referral of patients in outpatient settings.Based on a dynamic referral strategy which is time-dependent,a Markov decision model is used to model the referral of patients in inpatient settings.Next,analysis of the aforementioned patient flow models is carried out based on the actual cases.With the goal of achieving a balance in resource utilization between the two levels of medical institutions,a patient referral strategy based on parameters including community first diagnosis rate,the patient upward referral rate and the patientdownward referral rate is studied.With the goal of maximizing the total revenue of the two-level medical institutions,a patient referral strategy based on discrete states and finite decision-making periods is studied.Analysis of the simulation model in the patient outpatient referral scenario shows that the key to optimizing the outpatient referral strategy is to improve the community first diagnosis rate.Analysis of the Markov decision model shows that the level of resources of the medical institution,the length of decision-making and the willingness of patients to receive referrals all have an impact on the recommended referral strategy of the hospital.In order to achieve the optimal operation effect of the referral mechanism,the referral cooperation strategy should be determined by the medical institutions participating in the referral cooperation according to their actual situations.Finally,based on the above research content,an example of a patient's electronic referral process is realized and verified.An application prototype which can realize functions including user login,patient information query,referral decision support and patient referral operation is designed.On this basis,the patient referral process is carried out in combination with the patient referral process and referral strategy in the previous stud,and the usability of the prototype is verified.