Random effects models for operational patient pathways

Abstract

Patient flow modeling is a growing field of interest in health services research. Several techniques have been applied to model movement of patients within and between health-care facilities. However, individual patient experience during the delivery of care has always been overlooked. In this work, a random effects model is introduced to patient flow modeling and applied to a London Hospital Neonatal unit data. In particular, a random effects multinomial logit model is used to capture individual patient trajectories in the process of care with patient frailties modeled as random effects. Intuitively, both operational and clinical patient flow are modeled, the former being physical and the latter latent. Two variants of the model are proposed, one based on mere patient pathways and the other based on patient characteristics. Our technique could identify interesting pathways such as those that result in high probability of death (survival), pathways incurring the least (highest) cost of care or pathways with the least (highest) length of stay. Patient-specific discharge probabilities from the health care system could also be predicted. These are of interest to health-care managers in planning the scarce resources needed to run health-care institutions.

Keywords:

• patient flow
• frailty
• pathways
• transition

Acknowledgements

The authors acknowledge Jane Hawdon and Nicola J. Robertson, Elizabeth Garrett Anderson Institute for Women's Health, University College London, and Daniel Wood, Maternity and Neonatal Service, University College London Hospital for their help with data gathering and anonymization and clinical input. The authors also acknowledge the reviewers for their useful comments.