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An Optimization Model for the Tradeoff Between Efficiency and Equity for Mobile Stroke Unit Placement
Malmö University, Faculty of Technology and Society (TS), Department of Computer Science and Media Technology (DVMT).ORCID iD: 0000-0003-2769-4826
Malmö University, Faculty of Technology and Society (TS), Department of Computer Science and Media Technology (DVMT).
Malmö University, Faculty of Technology and Society (TS), Department of Computer Science and Media Technology (DVMT).
Region Skåne; Lund University.
2021 (English)In: Innovation in Medicine and Healthcare: Proceedings of 9th KES-InMed 2021, Springer, 2021, p. 183-193Conference paper, Published paper (Refereed)
Abstract [en]

A mobile stroke unit (MSU) is an ambulance, where stroke patients can be diagnosed and treated. Recently, placement of MSUs has been studied focusing on either maximum population coverage or equal service for all patients, termed efficiency and equity, respectively. In this study, we propose an unconstrained optimization model for the placement of MSUs, designed to introduce a tradeoff between efficiency and equity. The tradeoff is based on the concepts of weighted average time to treatment and the time difference between the expected time to treatment for different geographical areas. We conduct a case-study for Sweden’s Southern Health care Region (SHR), generating three scenarios (MSU1, MSU2, and MSU3) including 1, 2, and 3 MSUs, respectively. We show that our proposed optimization model can tune the tradeoff between the efficiency and equity perspectives for the MSU(s) allocation. This enables a high level of equal service for most inhabitants, as well as reducing the time to treatment for most inhabitants of a geographic region. In particular, placing three MSUs in the SHR with the proposed tradeoff, the share of inhabitants who are expected to receive treatment within an hour potentially improved by about a factor of 14 in our model.

Place, publisher, year, edition, pages
Springer, 2021. p. 183-193
Series
Smart Innovation, Systems and Technologies, ISSN 2190-3018, E-ISSN 2190-3026 ; 242
Keywords [en]
Driving time estimation, Efficient coverage, Equal treatment, Mobile stroke unit, Time to treatment, Tradeoff function, Efficiency, Optimization, Equal services, Expected time, Geographical area, Optimization modeling, Stroke patients, Time-differences, Unconstrained optimization, Weighted averages, Patient treatment
National Category
Communication Systems
Identifiers
URN: urn:nbn:se:mau:diva-45147DOI: 10.1007/978-981-16-3013-2_15Scopus ID: 2-s2.0-85111101237ISBN: 9789811630125 (print)OAI: oai:DiVA.org:mau-45147DiVA, id: diva2:1586882
Conference
9th KES-InMed 2021
Available from: 2021-08-23 Created: 2021-08-23 Last updated: 2024-02-05Bibliographically approved
In thesis
1. On the Use of Simulation and Optimization for the Analysis and Planning of Prehospital Stroke Care
Open this publication in new window or tab >>On the Use of Simulation and Optimization for the Analysis and Planning of Prehospital Stroke Care
2022 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Immediate treatment is of extreme importance for stroke patients. However, providing fast enough treatment for stroke patients is far from trivial, mainly due to logistical challenges and difficulties in diagnosing the correct stroke type. One way to reduce the time to treatment is to use so-called Mobile Stroke Units (MSUs), which allows to diagnose and provide treatment for stroke patients already at the patient scene. A well-designed stroke transport policy is vital to improve the access to treatment for stroke patients. Simulation and mathematical optimization are useful approaches for assessing and optimizing stroke transport policies, without endangering the health of the patients.

The main purpose of this thesis is to contribute to improving the situation for stroke patients and to reducing the social impacts of stroke. The aim is to study how to use simulation and optimization to achieve improved analysis and planning of prehospital stroke care. In particular, we focus on assessing the potential use of MSUs in a geographic area. In this thesis, optimization is used to identify the optimal locations of MSUs, and simulation is used to assess different stroke transport policies, including MSU locations. The results of this thesis aim to support public health authorities when making decisions in the prehospital stroke care domain.

In order to fulfill the aim of this thesis, we develop and analyze a number of different simulation and optimization models. First, we propose a macro-level simulation model, an average time to treatment estimation model, used to estimate the expected time to treatment for different parts of a geographic region. Using the proposed model, we generate two different MSU scenarios to explore the potential benefits of employing MSUs in Sweden’s southern healthcare region (SHR).  

Second, we present an optimization model to identify the best placement of MSUs while making a trade-off between the efficiency and equity perspectives, providing maximum population coverage and equal service for all patients, respectively. The trade-off function used in the model makes use of the concepts of weighted average time to treatment to model efficiency and the time difference between the expected time to treatment for different geographical areas to model equity. In a scenario study applied in the SHR, we evaluate our optimization model by comparing the current situation with three MSU scenarios, including 1, 2, and 3 MSUs.

Third, we present a micro-level discrete event simulation model to assess stroke transport policies, including MSUs, allowing us to model the behaviors of individual entities, such as patients and emergency vehicles, over time. We generate a synthetic set of stroke patients using a Poisson distribution, used as input in a scenario study.

Finally, we present a modeling framework with reusable components, which aims to facilitate the construction of discrete event simulation models in the emergency medical services domain. The framework consists of a number of generic activities, which can be used to represent healthcare chains modeled in the form of flowcharts. As the framework includes activities and policies modeled on the general level, the framework can be used to create models only by providing input data and a care chain specification. We evaluate the framework by using it to build a model for simulating EMS activities related to the complex case of acute stroke.

Place, publisher, year, edition, pages
Malmö: Malmö universitet, 2022. p. 55
Series
Studies in Computer Science ; 21
Keywords
Stroke Transport Policies, EMS, Mobile Stroke Unit, MSU, Simulation, Optimization, Modeling Framework.
National Category
Engineering and Technology
Identifiers
urn:nbn:se:mau:diva-55489 (URN)10.24834/isbn.9789178773039 (DOI)978-91-7877-304-6 (ISBN)978-91-7877-303-9 (ISBN)
Presentation
2022-10-18, 13:00 (English)
Opponent
Supervisors
Note

Note: The papers are not included in the fulltext online.

Available from: 2022-10-25 Created: 2022-10-24 Last updated: 2024-02-26Bibliographically approved

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Mahdiraji, Saeid AmouzadHolmgren, JohanMihailescu, Radu-Casian

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