End-to-End Outpatient Clinic Modeling for Performance Optimization and Scheduling in Health Care Service

Abstract

Decisions in health care must often be made under inherent uncertainty; from treating patients, to provisioning medical devices, to operational decisions at an outpatient clinic. The outcomes depend on the health of patients as well as the availability of health care professionals and resources. Complex models of clinic performance allow for experiments with new schedules and resource levels without the time, cost, unfeasibility, or risk of testing new policies in real clinics. Model-based methods quantify the effect of various uncertain factors such as the availability of personnel on health care quality indicators like patient wait times in a clinic. Despite their purported value, few opportunities have existed to test models from data collection through optimization. This dissertation develops a clinic model from end-to-end, beginning with a description of the medical practice, to data collection, to model validation, to optimization. Specialty medical practice is abstracted into treatment steps, measured electronically, and verified through systematic observation. These data are anonymized and made available for researchers. A validation framework uses the data to develop and test candidate models, selecting one that maximizes predictive accuracy while retaining interpretability and reproducibility. The resulting model is used in improving schedules via heuristic optimization. Clustering the results reveals clinic performance groups that represent different goals in clinic quality.