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From prediction to decision: Optimizing long‐term care placements among older delayed discharge patients

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Listed:
  • Ya‐Tang Chuang
  • Manaf Zargoush
  • Somayeh Ghazalbash
  • Saied Samiedaluie
  • Kerry Kuluski
  • Sara Guilcher

Abstract

This study examines long‐term care (LTC) discharge planning among older delayed discharge patients. While awaiting placements in alternate care such as LTC, these patients occupy hospital beds despite not requiring an intensive level of care. This study proposes a novel discharge decision model based on the Markov decision process (MDP) framework, which incorporates predictions regarding the patients' health trajectory and the associated hospital costs. Our machine learning (ML)‐based predictive analytics allow for considering heterogeneous health transitions, hence personalized decision making, leading to valuable information for reducing hospital costs. We also develop data‐driven cost functions using patient characteristics to estimate the person‐level costs associated with the decisions in the optimization model, that is, whether or not to discharge a patient to LTC. The data analyses and cost estimations are based on large historical data collected over 13 years in Ontario, Canada. To solve the resulting high‐dimensional MDP models, we develop an index policy, where each patient's index value is calculated using their health complexity (comorbidity), sex, age, and acute length of stay in the hospital. Using extensive numerical experiments, we illustrate the superior performance of the proposed index policy against some benchmarking policies and demonstrate the significance of predictive information in optimizing discharge decisions. Our results also indicate that the value of predictive information increases with LTC bed availability and decreases with hospital capacity. We also demonstrate that with the anticipated exacerbating mismatch between supply and demand, targeted prediction‐driven discharge policies, such as the proposed index policy, become even more critical.

Suggested Citation

  • Ya‐Tang Chuang & Manaf Zargoush & Somayeh Ghazalbash & Saied Samiedaluie & Kerry Kuluski & Sara Guilcher, 2023. "From prediction to decision: Optimizing long‐term care placements among older delayed discharge patients," Production and Operations Management, Production and Operations Management Society, vol. 32(4), pages 1041-1058, April.
  • Handle: RePEc:bla:popmgt:v:32:y:2023:i:4:p:1041-1058
    DOI: 10.1111/poms.13910
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    1. Christos H. Papadimitriou & John N. Tsitsiklis, 1999. "The Complexity of Optimal Queuing Network Control," Mathematics of Operations Research, INFORMS, vol. 24(2), pages 293-305, May.
    2. Hans B. Christensen & Eric Floyd & Mark Maffett, 2020. "The Only Prescription Is Transparency: The Effect of Charge-Price-Transparency Regulation on Healthcare Prices," Management Science, INFORMS, vol. 66(7), pages 2861-2882, July.
    3. Jonathan E. Helm & Adel Alaeddini & Jon M. Stauffer & Kurt M. Bretthauer & Ted A. Skolarus, 2016. "Reducing Hospital Readmissions by Integrating Empirical Prediction with Resource Optimization," Production and Operations Management, Production and Operations Management Society, vol. 25(2), pages 233-257, February.
    4. Carri W. Chan & Vivek F. Farias, 2009. "Stochastic Depletion Problems: Effective Myopic Policies for a Class of Dynamic Optimization Problems," Mathematics of Operations Research, INFORMS, vol. 34(2), pages 333-350, May.
    5. Vishal Ahuja & Carlos A. Alvarez & Bradley R. Staats, 2020. "Maintaining Continuity in Service: An Empirical Examination of Primary Care Physicians," Manufacturing & Service Operations Management, INFORMS, vol. 22(5), pages 1088-1106, September.
    6. Carri W. Chan & Vivek F. Farias & Nicholas Bambos & Gabriel J. Escobar, 2012. "Optimizing Intensive Care Unit Discharge Decisions with Patient Readmissions," Operations Research, INFORMS, vol. 60(6), pages 1323-1341, December.
    7. Xu Han & Niam Yaraghi & Ram Gopal, 2018. "Winning at All Costs: Analysis of Inflation in Nursing Homes’ Rating System," Production and Operations Management, Production and Operations Management Society, vol. 27(2), pages 215-233, February.
    8. Huiyin Ouyang & Nilay Tanık Argon & Serhan Ziya, 2020. "Allocation of Intensive Care Unit Beds in Periods of High Demand," Operations Research, INFORMS, vol. 68(2), pages 591-608, March.
    9. Michael Ketzenberg & Jacqueline Bloemhof & Gary Gaukler, 2015. "Managing Perishables with Time and Temperature History," Production and Operations Management, Production and Operations Management Society, vol. 24(1), pages 54-70, January.
    10. Yue Zhang & Martin L. Puterman & Matthew Nelson & Derek Atkins, 2012. "A Simulation Optimization Approach to Long-Term Care Capacity Planning," Operations Research, INFORMS, vol. 60(2), pages 249-261, April.
    11. Turgay Ayer & Can Zhang & Anthony Bonifonte & Anne C. Spaulding & Jagpreet Chhatwal, 2019. "Prioritizing Hepatitis C Treatment in U.S. Prisons," Operations Research, INFORMS, vol. 67(3), pages 853-873, May.
    12. David B. Brown & James E. Smith, 2020. "Index Policies and Performance Bounds for Dynamic Selection Problems," Management Science, INFORMS, vol. 66(7), pages 3029-3050, July.
    13. Dimitris Bertsimas & Allison O’Hair & Stephen Relyea & John Silberholz, 2016. "An Analytics Approach to Designing Combination Chemotherapy Regimens for Cancer," Management Science, INFORMS, vol. 62(5), pages 1511-1531, May.
    14. Ghazalbash, Somayeh & Zargoush, Manaf & Mowbray, Fabrice & Costa, Andrew, 2022. "Impact of multimorbidity and frailty on adverse outcomes among older delayed discharge patients: Implications for healthcare policy," Health Policy, Elsevier, vol. 126(3), pages 197-206.
    15. Diwas Singh KC & Christian Terwiesch, 2017. "Benefits of Surgical Smoothing and Spare Capacity: An Econometric Analysis of Patient Flow," Production and Operations Management, Production and Operations Management Society, vol. 26(9), pages 1663-1684, September.
    16. Abderrahmane Abbou & Viliam Makis, 2019. "Group Maintenance: A Restless Bandits Approach," INFORMS Journal on Computing, INFORMS, vol. 31(4), pages 719-731, October.
    17. Noa Zychlinski & Avishai Mandelbaum & Petar Momčilović & Izack Cohen, 2020. "Bed Blocking in Hospitals Due to Scarce Capacity in Geriatric Institutions—Cost Minimization via Fluid Models," Manufacturing & Service Operations Management, INFORMS, vol. 22(2), pages 396-411, March.
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