论文标题

通过预测患者未出现的行为来改善医疗保健访问管理

Improving healthcare access management by predicting patient no-show behaviour

论文作者

Ferro, David Barrera, Brailsford, Sally, Bravo, Cristián, Smith, Honora

论文摘要

医疗预约的出勤水平较低与服务提供者的健康状况不佳和效率问题有关。为了解决这个问题,医疗保健经理可以通过调整资源分配政策来提高出勤水平或最大程度地降低未分布的运营影响。但是,鉴于患者行为的不确定性,生成有关未出现概率的相关信息可以支持两种方法的决策过程。在这种情况下,许多研究人员使用多个回归模型来识别患者和任命特征,而不是用作未出现概率的良好预测指标。这项工作开发了一个决策支持系统(DSS),以支持实施鼓励出席的策略,以针对哥伦比亚波哥大服务不足社区的预防保健计划。我们对文学的贡献是三倍。首先,我们评估了不同机器学习方法的有效性,以提高回归模型的准确性。特别是,随机森林和神经网络用于建模问题,以解决非线性和可变相互作用的问题。其次,我们提出了层次相关性传播的新颖使用,以提高神经网络预测的解释性并从建模步骤中获得见解。第三,我们确定了在发展中环境中解释未出现概率的变量,并研究其政策含义和改善医疗保健访问的潜力。除了量化以前的研究中报告的关系外,我们还发现收入和邻里犯罪统计数据会影响未出现的概率。我们的结果将支持患者在行为干预中的优先级,并将为任命计划决定提供信息。

Low attendance levels in medical appointments have been associated with poor health outcomes and efficiency problems for service providers. To address this problem, healthcare managers could aim at improving attendance levels or minimizing the operational impact of no-shows by adapting resource allocation policies. However, given the uncertainty of patient behaviour, generating relevant information regarding no-show probabilities could support the decision-making process for both approaches. In this context many researchers have used multiple regression models to identify patient and appointment characteristics than can be used as good predictors for no-show probabilities. This work develops a Decision Support System (DSS) to support the implementation of strategies to encourage attendance, for a preventive care program targeted at underserved communities in Bogotá, Colombia. Our contribution to literature is threefold. Firstly, we assess the effectiveness of different machine learning approaches to improve the accuracy of regression models. In particular, Random Forest and Neural Networks are used to model the problem accounting for non-linearity and variable interactions. Secondly, we propose a novel use of Layer-wise Relevance Propagation in order to improve the explainability of neural network predictions and obtain insights from the modelling step. Thirdly, we identify variables explaining no-show probabilities in a developing context and study its policy implications and potential for improving healthcare access. In addition to quantifying relationships reported in previous studies, we find that income and neighbourhood crime statistics affect no-show probabilities. Our results will support patient prioritization in a pilot behavioural intervention and will inform appointment planning decisions.

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