A hybrid data mining/simulation approach for modelling outpatient no-shows in clinic scheduling

This paper considers the outpatient no-show problem faced by a rural free clinic located in the south-eastern United States. Using data mining and simulation techniques, we develop sequencing schemes for patients, in order to optimize a combination of performance measures used at the clinic. We utilize association rule mining (ARM) to build a model for predicting patient no-shows; and then use a set covering optimization method to derive three manageable sets of rules for patient sequencing. Simulation is used to determine the optimal number of patients and to evaluate the models. The ARM technique presented here results in significant improvements over models that do not employ rules, supporting the conjecture that, when dealing with noisy data such as in an outpatient clinic, extracting partial patterns, as is done by ARM, can be of significant value for simulation modelling.

[1]  Rafael Martí,et al.  The OptQuest Callable Library , 2003 .

[2]  Stephen R. Lawrence,et al.  Clinic Overbooking to Improve Patient Access and Increase Provider Productivity , 2007, Decis. Sci..

[3]  M. DeHaven,et al.  Perspectives on Adherence to Recommended Health Behavior among Low-Income Patients , 2001 .

[4]  Thomas R. Rohleder,et al.  Scheduling outpatient appointments in a dynamic environment , 1996 .

[5]  Svetlozar Nestorov,et al.  Comprehensive data warehouse exploration with qualified association-rule mining , 2006, Decis. Support Syst..

[6]  Rolf Stadler,et al.  Discovering Data Mining: From Concept to Implementation , 1997 .

[7]  E F Cook,et al.  A multivariate approach to the prediction of no-show behavior in a primary care center. , 1982, Archives of internal medicine.

[8]  S. D. Roberts,et al.  Simulation Modeling and Health-care Decision Making , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[9]  Sheldon Howard Jacobson,et al.  Application of discrete-event simulation in health care clinics: A survey , 1999, J. Oper. Res. Soc..

[10]  A R Mahachek An introduction to patient flow simulation for health-care managers. , 1992, Journal of the Society for Health Systems.

[11]  C. Apte,et al.  Data mining with decision trees and decision rules , 1997, Future Gener. Comput. Syst..

[12]  Emre A. Veral,et al.  OUTPATIENT SCHEDULING IN HEALTH CARE: A REVIEW OF LITERATURE , 2003 .

[13]  John Fry,et al.  Appointments in General Practice , 1964 .

[14]  Xing Zhang,et al.  A new approach to classification based on association rule mining , 2006, Decis. Support Syst..

[15]  D. V. Lindley,et al.  The theory of queues with a single server , 1952, Mathematical Proceedings of the Cambridge Philosophical Society.

[16]  Julie C. Lowery Introduction to simulation in health care , 1996, Winter Simulation Conference.

[17]  Ming Guo,et al.  Outpatient clinic scheduling - a simulation approach , 2004, Proceedings of the 2004 Winter Simulation Conference, 2004..

[18]  Christos Vasilakis,et al.  A simulation study of scheduling clinic appointments in surgical care: individual surgeon versus pooled lists , 2007, J. Oper. Res. Soc..

[19]  John Fry Appointments Systems in Hospitals and General Practice: Appointments in General Practice , 1964 .

[20]  Keith C. C. Chan,et al.  Mining fuzzy association rules in a bank-account database , 2003, IEEE Trans. Fuzzy Syst..

[21]  M. Brandreth,et al.  A simulation-based study of a NHS Walk-in Centre , 2005, J. Oper. Res. Soc..

[22]  Ray J. Paul,et al.  Simulation modelling in healthcare: reviewing legacies and investigating futures , 2007, J. Oper. Res. Soc..

[23]  Hsinchun Chen,et al.  Large-scale regulatory network analysis from microarray data: modified Bayesian network learning and association rule mining , 2007, Decis. Support Syst..

[24]  Mahachek Ar,et al.  An introduction to patient flow simulation for health-care managers. , 1992 .

[25]  William Shonick,et al.  An Approach to Reducing the Adverse Effects of Broken Appointments in Primary Care Systems , 1977, Medical care.

[26]  Emre A. Veral,et al.  Assessment of patient classification in appointment system design , 2008 .

[27]  C. Lemay,et al.  Patient Health Status and Appointment Keeping in an Urban Community Health Center , 2004, Journal of health care for the poor and underserved.

[28]  Tomasz Imielinski,et al.  Mining association rules between sets of items in large databases , 1993, SIGMOD Conference.

[29]  J. Talaga,et al.  Predicting appointment breaking. , 1995, Journal of health care marketing.

[30]  V. Smith-Daniels,et al.  Capacity Management in Health Care Services: Review and Future Research Directions* , 1988 .

[31]  Murray J. Côté,et al.  Patient flow and resource utilization in an outpatient clinic , 1999 .

[32]  Diwakar Gupta,et al.  Appointment scheduling in health care: Challenges and opportunities , 2008 .

[33]  Balaji Rajagopalan,et al.  Data Mining to Support Simulation Modeling of Patient Flow in Hospitals , 2002, Journal of Medical Systems.

[34]  R. Javalgi,et al.  Tackling no-show behavior: a market-driven approach. , 1998, Health marketing quarterly.

[35]  A. Schuster,et al.  Association rule mining in peer-to-peer systems , 2004, IEEE Trans. Syst. Man Cybern. Part B.

[36]  Padhraic Smyth,et al.  An Information Theoretic Approach to Rule Induction from Databases , 1992, IEEE Trans. Knowl. Data Eng..

[37]  X. Huang,et al.  Patient Attitude towards Waiting in an Outpatient Clinic and its Applications , 1994, Health services management research.

[38]  H G Dove,et al.  The Usefulness of Patients' Individual Characteristics in Predicting No-Shows in Outpatient Clinics , 1981, Medical care.

[39]  R Ceglowski,et al.  Combining Data Mining and Discrete Event Simulation for a value-added view of a hospital emergency department , 2007, J. Oper. Res. Soc..

[40]  Martin L. Puterman,et al.  Improving resource utilization for diagnostic services through flexible inpatient scheduling: A method for improving resource utilization , 2007, J. Oper. Res. Soc..

[41]  Hon-Shiang Lau,et al.  Minimizing total cost in scheduling outpatient appointments , 1992 .

[42]  Mohan M. Nadkarni,et al.  Free Clinics: A National Survey , 2005, The American journal of the medical sciences.

[43]  T. Cox,et al.  Optimising the queuing system for an ear, nose and throat outpatient clinic , 1985 .

[44]  D. Sharp,et al.  Non-attendance at general practices and outpatient clinics , 2001, BMJ : British Medical Journal.

[45]  N. Bailey A Study of Queues and Appointment Systems in Hospital Out‐Patient Departments, with Special Reference to Waiting‐Times , 1952 .

[46]  R. Chez,et al.  The no-show rate in a high-risk obstetric clinic. , 2000, Journal of women's health & gender-based medicine.

[47]  Norman T. J. Baii A STUDY OF QUEUES AND APPOINTMENT SYSTEMS IN HOSPITAL OUT-PATIENT DEPARTMENTS, WITH SPECIAL REFERENCE TO WAITING-TIMES , 1952 .