医院门诊预约系统的优化分析：基于国内某大型医院的研究

发布时间：2017-12-26 19:27

本文关键词：医院门诊预约系统的优化分析：基于国内某大型医院的研究　出处：《中国科学技术大学》2017年硕士论文　论文类型：学位论文

【摘要】：随着经济的发展,人们对医疗健康服务的质量和效率也愈发关注。由于人口基数庞大以及老龄化的日益加重,人们对于优质医疗资源的需求也日益增加。优质医疗资源供不应求以及得不到有效利用是国内大型公立医院所面临的问题。尽管医院已经实施了预约挂号的就诊方式,但医院的一些热门科室还是会出现大排长龙的现象。长时间的等待与短暂的就诊时间,造成病人对医院产生不满。医生工作负担的增加导致医院在管理运营上的费用也在增长。因此,对预约系统的设计研究从现实上来说是十分必要。本文是以国内大型医院的门诊预约系统为主要研究对象,深入剖析医院的预约系统在实际运营中所产生的问题。在系统的实际运行过程中,不确定的需求、随机的服务时间、预约患者爽约行为以及未预约患者的随机到达等因素都有可能会打乱医院原有的预约安排,增加病人的等待时间,引起医生不必要的加班和空闲时间。为了减少这些因素对预约系统的影响,医院需要对即将接收的病人进行合理安排。本课题为了应对上述不确定因素所带来的不良影响,对门诊预约调度方法进行了研究。本文的主要研究工作如下:(1)门诊预约系统的研究概况。通过对国内外相关问题的文献调查发现,国外对于预约系统的调度问题研究比较系统,但对于未预约患者的研究相对较少。而国内由于起步晚,对预约调度问题的研究相对于国外还不是很成熟,很多模型都是基于国外研究的基础上进行拓展研究的,适合国内医院情况的比较少。因此,依托我国现阶段医院常采用的预约系统,分析现阶段国内预约系统所存在的问题和对预约模型进行优化使之更适合我国医院现阶段的情况,是十分具有研究价值和现实意义的。(2)全预约的分时段预约模式和部分预约的预约模式的对比。本文针对国内常用的两种预约方式在爽约率、未预约病人所占比例以及成本系数比例等参数改变的情形下通过数值实验进行了比对研究,发现爽约概率对于两个模式的预约安排影响比较明显。当爽约率偏低以及空闲时间成本系数相对较大时,部分预约模式的表现要比全预约模式要好。即使当爽约率高时,增加未预约病人所占的比例并不能有效弥补医院由于爽约而带来的损失。(3)带有临时需求和爽约行为的分时段预约模式的研究。基于国内大型医院的具体情况,本文通过联合决策医院对预约病人的调度安排和对未预约病人的接收容量以最大化医院收益为目标建立了序贯性的分时段预约调度系统,并给出了问题的求解方法。在此模型中,未预约病人的到达假设服从泊松分布,预约病人的优先等级高于未预约病人,同时段的同类型病人按照先来后到的次序进行就诊,病人的服务时间服从指数分布。通过数值实验验证了模型的适用性,并且发现成本比例系数对总体收益的影响较大。
[Abstract]:With the development of the economy, people pay more attention to the quality and efficiency of medical health service. Because of the huge population base and the increasing aging, the demand for high quality medical resources is increasing. The shortage of high quality medical resources and the lack of effective utilization are the problems facing large public hospitals in China. Although the hospital has already implemented the appointment registration way of visiting, but some of the hot sections of the hospital still have the phenomenon of long long dragon. For a long time and a short visit, the patient was dissatisfied with the hospital. The increase in the burden of doctors' work has led to the increase in the cost of the hospital in management and operation. Therefore, it is very necessary to study the design of the reservation system in reality. This paper is based on the outpatient appointment system of large hospitals in China as the main research object, and analyzes the problems in the actual operation of the hospital reservation system. In the actual operation process of the system, random arrival factors such as uncertain demand, random Business Hours, appointment Miss behavior patients and patients without reservation are likely to disrupt the original hospital appointment, increase the waiting time of the patient, the doctor caused unnecessary overtime and idle time. In order to reduce the impact of these factors on the reservation system, the hospital needs to make reasonable arrangements for the patients to be received. In order to cope with the adverse effects of the above uncertain factors, this paper studies the outpatient appointment scheduling method. The main research work of this paper is as follows: (1) the survey of the outpatient appointment system. Through literature review on related issues at home and abroad, it is found that the research on scheduling problem of appointment system abroad is relatively systematic, but there is relatively little research on unreserved patients. However, due to the late start, the research on the appointment scheduling problem is not very mature compared with foreign countries. Many models are expanded based on the research abroad, and are suitable for domestic hospitals. Therefore, relying on the appointment system commonly used at present stage in our hospital, it is of great research value and practical significance to analyze the problems existing in the current domestic reservation system and optimize the appointment model to make it more suitable for the current stage of our hospital. (2) the comparison of the fully reserved time interval reservation mode and the reservation mode of the partial reservation. The comparison of numerical experiments for the change of parameter in the case of two kinds of appointment at home, not miss rate appointment proportion and cost coefficient ratio, the probability for the two Miss found mode of appointment obvious effect. When the miss rate is low and the idle time cost coefficient is relatively large, part of the booking mode of the performance is better than full reservation mode. Even when the miss rate is high, increasing the proportion of patients without reservation and cannot effectively make up for the hospital due to miss the loss. (3) the research period of a temporary demand and miss behavior appointment mode. The specific circumstances of the domestic large hospitals based on the joint decision of the hospital appointment schedule and to walk-in patients receiving capacity to maximize the return on the hospital was established in order to time sequential appointment scheduling system, and gives the method of solving the problem. In this model, not the patient's arrival is assumed to be Poisson distribution, priority reservation of patients was higher than that of the patient, the same type of patients at the same time of treatment in accordance with the order of the patient in order of arrival, Business Hours exponential distribution. The applicability of the model is verified by numerical experiments, and it is found that the cost ratio coefficient has a great influence on the overall income.
【学位授予单位】：中国科学技术大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.3

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