【作者】 赵欣；

【导师】 张欣莉；

【作者基本信息】 四川大学 ， 工业工程（专业学位）， 2021， 硕士

【摘要】 随着慢病管理的需求增加,线上与线下相结合的慢病复诊新模式随之出现。但慢病复诊患者多选择线下门诊复诊,导致线下门诊出现拥堵现象,线上的网络门诊利用率较低,综合医院的复诊供给和慢病复诊患者的需求之间出现了匹配失衡。为解决此问题,有研究者提出网络门诊专家坐诊、网络门诊存储预付款等方法,通过增加线上服务时长或降低线上成本来引导复诊患者流向线上网络门诊,改善匹配失衡。基于问题和研究基础,本文同时考虑线上线下合理的服务时长、总路径服务成本最小的匹配要求,将时长过长造成的拥堵排队转化为等待成本,提出单日复诊系统总成本最小的目标,开展线上线下新模式下的供需匹配优化研究。本文结合医院实际就诊情况,归纳慢病患者进入综合医院接受复诊时的流程和节点,设计系统概念模型,引入了Jackson排队网络相关理论,构建慢病复诊排队网络,通过对患者流的引导得到使单日复诊系统总成本最小的匹配优化策略。其中,在建立层级服务系统时,首先识别慢病复诊患者的层级需求,适当减少复诊患者服务需求的随机性,其次设计慢病服务包的功能为提供线下复诊的绿色通道、节约检查检验费用,提供线上网络诊疗服务增加就诊选择,拓宽供给量,以在不同层级需求下建立双渠道多路径的服务供给。在进行模型构建和仿真算例时,参考四川省某大型综合医院2017年因高血压复诊的门诊患者数据作为仿真参数,通过决策变量慢病服务包签约率和网络门诊诊疗率的改变,给出复诊患者成本最小化的复诊选择方案,实现患者层级需求和层级服务供给的精准匹配,利用灵敏度分析提出线上线下新模式下基于匹配比例的策略和建议。在慢病复诊系统中实现了合理的患者流结构优化和价格供给策略建议。应用研究表明,本文的优化办法可以满足综合医院线上线下复诊新模式下的慢病患者复诊需求,且通过对患者流的引导释放了门诊压力、降低了复诊成本,实现合理供需匹配,有益地补充了医疗供需研究的内容。更多还原

【Abstract】 As the demand for chronic disease management increases,a new model of chronic disease follow-ups combining online and offline has emerged.However,revisit patients often choose offline outpatient follow-up consultations,resulting in congestion in offline outpatient clinics.The utilization rate of online network outpatient clinics is low.There is a matching imbalance between the supply of follow-up consultations in general hospitals and the needs of chronic disease follow-up patients.To solve this problem some researchers have proposed methods such as online outpatient consultation by experts and online outpatient storage prepayments,which can improve the balancement of matching by increasing online service time or reducing online service costs to guide returning patients to online online outpatient clinics.Based on the problem and research foundation,this paper also considers the matching requirements of reasonable online and offline service time and minimum total path service cost,and converts the congestion caused by the long time into waiting costs,and proposes the goal of the minimum total cost of the single-day follow-up diagnosis system.Carry out research on the optimization of supply and demand matching under the new online and offline model.Based on the hospital visits,this paper summarizes the flow and nodes when patients with chronic diseases enter general hospitals for follow-up visits,designs the conceptual model of the system,introduces the related theory of Jackson’s queuing network,and builds a follow-up queuing network for chronic diseases revisit patients,and obtains orders by guiding the flow of patients.The matching optimization strategy with the smallest total cost of the daily follow-up diagnosis system.Among them,when establishing a hierarchical service system,firstly identify the tiered needs of patients returning to chronic diseases,and appropriately reduce the randomness of the service needs of revisit patients.Secondly,the function of the chronic disease service package is designed to provide a green channel for offline follow-up visits and save inspection and inspection costs.,Provide online network diagnosis and treatment services to increase the choice of treatment and expand the supply volume,so as to establish a dual-channel and multi-path service supply under different levels of demand.In the model construction and simulation examples,the data of outpatients returning for hypertension in a large general hospital in Sichuan Province in 2017 were used as simulation parameters,and the changes in the contracting rate of chronic disease service packages and the changes in the network outpatient diagnosis and treatment rate were given by the decision variables The return visit selection plan that minimizes the cost of return visits to achieve the precise matching of patient-level needs and hierarchical service supply,and uses sensitivity analysis to propose strategies and recommendations based on matching ratios under the new online and offline model.In the chronic disease follow-up diagnosis system,reasonable patient flow structure optimization and price supply strategy recommendations have been realized.Application research shows that the optimized method in this paper can meet the needs of chronic disease patients under the new mode of online and offline follow-up visits in general hospitals,and releases the pressure of outpatient clinics through the guidance of patient flow,reduces the cost of follow-up visits,and achieves reasonable supply and demand matching.Supplements the content of medical supply and demand research.更多还原