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Related Experiment Videos

Modeling hospital infrastructure by optimizing quality, accessibility and efficiency via a mixed integer programming

David Ikkersheim¹, Marit Tanke, Gwendy van Schooten

¹KPMG Plexus, Breukelen, The Netherlands. Ikkersheim.david@kpmgplexus.nl

BMC Health Services Research

|June 18, 2013

Summary

This study introduces a new model for hospital infrastructure allocation, balancing quality, efficiency, and accessibility. It suggests chronic care may be too concentrated and acute care too dispersed in the Netherlands.

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Area of Science:

Health Services Research
Operations Research
Public Health Policy

Background:

Most curative healthcare is hospital-based, with 94 locations in the Netherlands offering diverse treatments.
Existing hospital allocation studies prioritize accessibility and efficiency over quality.
Quality improvements are linked to care concentration for complex conditions and dispersion for chronic ones.

Purpose of the Study:

To explore incorporating a quality function into hospital infrastructure allocation models.
To determine optimal hospital infrastructure for the Dutch context by balancing quality, efficiency, and accessibility.
To provide global directions for 'optimal' hospital infrastructure planning.

Main Methods:

Utilized a mathematical mixed integer programming (MIP) model.
Balanced quality, efficiency, and accessibility for 30 ICD-9 diagnosis groups.
Considered volume-outcome relationships, travel times for emergency care, and minimum facility usage.

Main Results:

Optimal hospital locations varied significantly by diagnosis group.
12-14 locations are optimal for high-volume-outcome relationship groups (e.g., neoplasms).
150 locations are optimal for chronic conditions (e.g., diabetes, COPD).

Conclusions:

Presents a novel approach for national/regional hospital infrastructure allocation, integrating quality and volume-outcome relationships.
Suggests potential over-concentration of chronic care and under-concentration of acute care in the Netherlands.
The model is adaptable to other regions and suitable for 'what-if' scenario analysis.