Optimal Location, Patient Routing, and Capacity Decisions for Endoscopy Clinical Network in Western Ontario: A Simulation-based Optimization Approach
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Date
2015-05-22
Authors
Akhundov, Najmaddin
Advisor
Journal Title
Journal ISSN
Volume Title
Publisher
University of Waterloo
Abstract
Thousands of Canadians die or suffer from colorectal cancer (CRC) every year.
Unawareness of risk factors and the lack of sufficient screening capacity contributes to
these numbers. In Ontario, CRC death rates are high, therefore, the Ministry of Health
and Cancer Care Ontario and Long-Term Care have launched a population-based
provincial colorectal cancer screening program. Considering that it is 92% curable if
detected early, it is crucial for people to have access to screening facilities for routine
screening to avoid serious consequences.
In this study, we develop a simulation-based optimization approach to find most
favorable facility locations, along with the necessary number of staff, equipment, and
dedicated rooms within each facility to provide three endoscopy screening services:
Colonoscopy, Gastroscopy, and Flexible-Sigmoidoscopy. The model and its results may
provide insights to policy makers in facilitating public access to endoscopy screening
resources in Ontario.
We developed a discrete-event simulation model to mimic the parallel processes
within an endoscopy clinic in order to estimate the associated utilizations of resources
and average waiting times of all patient groups. The simulation model is used to
iteratively test the desired number of doctors, nurses, and rooms within the facility for a
given demand rate. Then, we integrated the simulation model with a search-based
approximate-optimization algorithm which searches different sets of facility locations to
open as well as capacity levels to allocate in each location, and estimate the expected
total cost. The aim of the algorithm is to provide a location capacity decision that
minimizes the expected total cost given that expected waiting times are within
acceptable limits.
Description
Keywords
Health Care Delivery, Simulation-based Optimization, Location-allocation Analysis, Discrete-event Simulation, Cancer Screening, Colonoscopy, Flexible- sigmoidoscopy, Gastroscopy, Simulated Annealing, Greedy Heuristic