Design and analysis of ambulance diversion policies

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Description
Overcrowding of Emergency Departments (EDs) put the safety of patients at risk. Decision makers implement Ambulance Diversion (AD) as a way to relieve congestion and ensure timely treatment delivery. However, ineffective design of AD policies reduces the accessibility to emergency

Overcrowding of Emergency Departments (EDs) put the safety of patients at risk. Decision makers implement Ambulance Diversion (AD) as a way to relieve congestion and ensure timely treatment delivery. However, ineffective design of AD policies reduces the accessibility to emergency care and adverse events may arise. The objective of this dissertation is to propose methods to design and analyze effective AD policies that consider performance measures that are related to patient safety. First, a simulation-based methodology is proposed to evaluate the mean performance and variability of single-factor AD policies in a single hospital environment considering the trade-off between average waiting time and percentage of time spent on diversion. Regression equations are proposed to obtain parameters of AD policies that yield desired performance level. The results suggest that policies based on the total number of patients waiting are more consistent and provide a high precision in predicting policy performance. Then, a Markov Decision Process model is proposed to obtain the optimal AD policy assuming that information to start treatment in a neighboring hospital is available. The model is designed to minimize the average tardiness per patient in the long run. Tardiness is defined as the time that patients have to wait beyond a safety time threshold to start receiving treatment. Theoretical and computational analyses show that there exists an optimal policy that is of threshold type, and diversion can be a good alternative to decrease tardiness when ambulance patients cause excessive congestion in the ED. Furthermore, implementation of AD policies in a simulation model that accounts for several relaxations of the assumptions suggests that the model provides consistent policies under multiple scenarios. Finally, a genetic algorithm is combined with simulation to design effective policies for multiple hospitals simultaneously. The model has the objective of minimizing the time that patients spend in non-value added activities, including transportation, waiting and boarding in the ED. Moreover, the AD policies are combined with simple ambulance destination policies to create ambulance flow control mechanisms. Results show that effective ambulance management can significantly reduce the time that patients have to wait to receive appropriate level of care.
Date Created
2011
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Integrative analyses of diverse biological data sources

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Description
The technology expansion seen in the last decade for genomics research has permitted the generation of large-scale data sources pertaining to molecular biological assays, genomics, proteomics, transcriptomics and other modern omics catalogs. New methods to analyze, integrate and visualize these

The technology expansion seen in the last decade for genomics research has permitted the generation of large-scale data sources pertaining to molecular biological assays, genomics, proteomics, transcriptomics and other modern omics catalogs. New methods to analyze, integrate and visualize these data types are essential to unveil relevant disease mechanisms. Towards these objectives, this research focuses on data integration within two scenarios: (1) transcriptomic, proteomic and functional information and (2) real-time sensor-based measurements motivated by single-cell technology. To assess relationships between protein abundance, transcriptomic and functional data, a nonlinear model was explored at static and temporal levels. The successful integration of these heterogeneous data sources through the stochastic gradient boosted tree approach and its improved predictability are some highlights of this work. Through the development of an innovative validation subroutine based on a permutation approach and the use of external information (i.e., operons), lack of a priori knowledge for undetected proteins was overcome. The integrative methodologies allowed for the identification of undetected proteins for Desulfovibrio vulgaris and Shewanella oneidensis for further biological exploration in laboratories towards finding functional relationships. In an effort to better understand diseases such as cancer at different developmental stages, the Microscale Life Science Center headquartered at the Arizona State University is pursuing single-cell studies by developing novel technologies. This research arranged and applied a statistical framework that tackled the following challenges: random noise, heterogeneous dynamic systems with multiple states, and understanding cell behavior within and across different Barrett's esophageal epithelial cell lines using oxygen consumption curves. These curves were characterized with good empirical fit using nonlinear models with simple structures which allowed extraction of a large number of features. Application of a supervised classification model to these features and the integration of experimental factors allowed for identification of subtle patterns among different cell types visualized through multidimensional scaling. Motivated by the challenges of analyzing real-time measurements, we further explored a unique two-dimensional representation of multiple time series using a wavelet approach which showcased promising results towards less complex approximations. Also, the benefits of external information were explored to improve the image representation.
Date Created
2011
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