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SIGSIMPADS 2016
CouplingSimulation with MachineLearning:
A Hybrid Approachfor Elderly DischargePlanning
Mahmoud Elbattah, Owen Molloy
m.elbattah1@nuigalway.ie
SIGSIMPADS 2016
Challenge to Healthcare: PopulationAgeing
2Source : Health Service Executive. Annual Report and Financial Statements, 2014.
SIGSIMPADS 2016
Our Focus: Hip Fracture Care in Ireland
• A good exemplar of elderly healthcare.
• Exponentially increasing with age.1
• Identified as one of the most serious injuries resulting in
lengthy hospital admissions and high costs.2
• High quality data available through the Irish Hip Fracture
Database (IHFD).
3
Sources :1 Gullberg, B., Johnell, O. and Kanis, J.A., 1997. World-wide projections for hip fracture. Osteoporosis international, 7(5), pp.407-413.
2http://www.hse.ie/eng/services/publications/olderpeople/Executive_Summary_Strategy_to_Prevent_Falls_and_Fractures_in_Ireland%E2%80%99s_Ageing_Po
pulation.pdf
SIGSIMPADS 2016
Questions of Interest
4
Category of
Questions
Question
Individual Patient-
Level
Q1) Given an elderly patient’s characteristics, how to predict the
length of stay in acute facilities?
Q2) Given an elderly patient’s characteristics, how to predict the
discharge destination?
Population-Level Q3) What is the expected proportion of elderly patients
discharged to home, or long-stay care?
Q4) How adequate is the geographic distribution of long-stay care
facilities with respect to the demographic profile of elderly people
in Ireland?
SIGSIMPADS 2016
Our Approach: Integrating Simulation
Modeling with Machine Learning
Machine Learning
Predict LOS and
Destination Discharge
Patient-Focused Perspective
+ Simulation Modeling
Modeling Projected
Flow of Elderly Patients
Population-Driven Perspective
SIGSIMPADS 2016
Approach Overview
6
SIGSIMPADS 2016
DES Model : The Patient Journey
7
SIGSIMPADS 2016
Models Training
8
Relative Absolute Error Relative SquaredError Coefficientof Determination
≈0.26 ≈0.17 ≈0.83
Average 10-fold cross-validationaccuracy of the LOS predictor
Average 10-fold cross-validationaccuracies of discharge destination classifier.
SIGSIMPADS 2016
Experiments & Results
9
0
500
1000
1500
2000
2500
3000
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
ElderlyPatients
Year
Male Patients Female Patients
SIGSIMPADS 2016
Experiments & Results (cont’d)
10
0
500
1000
1500
2000
2500
2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026
DischargedPatients
Year
Home Long-Stay Care
SIGSIMPADS 2016
Experiments & Results (cont’d)
11
(a) Bed Capacity (Long-Stay Care) (b) Predicted Demand
CHO: Community Health Organisation
SIGSIMPADS 2016
Study Limitations
• Only public acute hospitals were considered, from which the
IHFD records were obtained.
• The records of the IHFD dataset did not evenly represent the 9
CHOs.
• The real data obtained by the study covered only a single year,
which was 2013.
• The rate of hip fractures was assumed as a constant over the
simulated interval, however it might increase or decrease in
reality.
12
SIGSIMPADS 2016
Discussion: The Role of Machine Learning
13
SIGSIMPADS 2016
Discussion: The Role of Machine Learning
(cont’d)
14
SIGSIMPADS 2016
Summary
• The developed model can realise a population-based
perspective for care delivery of hip fracture care in
particular.
• The combined approach of simulation modeling and ML is
claimed to increase the simulation model accuracy.
• Further, the model can further serve as a surrogate model
for expecting the potential demand for elderly care in
general.
15
SIGSIMPADS 2016
Acknowledgements
• PhD Supervisor: Owen Molloy.
• National Office of Clinical Audit (NOCA), Ireland.
• SIGSIM PADS.
• The reviewers of our paper.
16
SIGSIMPADS 2016
THANK YOU!
Mahmoud Elbattah
m.elbattah1@nuigalway.ie

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Coupling Simulation with Machine Learning:A Hybrid Approach for Elderly Discharge Planning

  • 1. SIGSIMPADS 2016 CouplingSimulation with MachineLearning: A Hybrid Approachfor Elderly DischargePlanning Mahmoud Elbattah, Owen Molloy m.elbattah1@nuigalway.ie
  • 2. SIGSIMPADS 2016 Challenge to Healthcare: PopulationAgeing 2Source : Health Service Executive. Annual Report and Financial Statements, 2014.
  • 3. SIGSIMPADS 2016 Our Focus: Hip Fracture Care in Ireland • A good exemplar of elderly healthcare. • Exponentially increasing with age.1 • Identified as one of the most serious injuries resulting in lengthy hospital admissions and high costs.2 • High quality data available through the Irish Hip Fracture Database (IHFD). 3 Sources :1 Gullberg, B., Johnell, O. and Kanis, J.A., 1997. World-wide projections for hip fracture. Osteoporosis international, 7(5), pp.407-413. 2http://www.hse.ie/eng/services/publications/olderpeople/Executive_Summary_Strategy_to_Prevent_Falls_and_Fractures_in_Ireland%E2%80%99s_Ageing_Po pulation.pdf
  • 4. SIGSIMPADS 2016 Questions of Interest 4 Category of Questions Question Individual Patient- Level Q1) Given an elderly patient’s characteristics, how to predict the length of stay in acute facilities? Q2) Given an elderly patient’s characteristics, how to predict the discharge destination? Population-Level Q3) What is the expected proportion of elderly patients discharged to home, or long-stay care? Q4) How adequate is the geographic distribution of long-stay care facilities with respect to the demographic profile of elderly people in Ireland?
  • 5. SIGSIMPADS 2016 Our Approach: Integrating Simulation Modeling with Machine Learning Machine Learning Predict LOS and Destination Discharge Patient-Focused Perspective + Simulation Modeling Modeling Projected Flow of Elderly Patients Population-Driven Perspective
  • 7. SIGSIMPADS 2016 DES Model : The Patient Journey 7
  • 8. SIGSIMPADS 2016 Models Training 8 Relative Absolute Error Relative SquaredError Coefficientof Determination ≈0.26 ≈0.17 ≈0.83 Average 10-fold cross-validationaccuracy of the LOS predictor Average 10-fold cross-validationaccuracies of discharge destination classifier.
  • 9. SIGSIMPADS 2016 Experiments & Results 9 0 500 1000 1500 2000 2500 3000 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 ElderlyPatients Year Male Patients Female Patients
  • 10. SIGSIMPADS 2016 Experiments & Results (cont’d) 10 0 500 1000 1500 2000 2500 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 DischargedPatients Year Home Long-Stay Care
  • 11. SIGSIMPADS 2016 Experiments & Results (cont’d) 11 (a) Bed Capacity (Long-Stay Care) (b) Predicted Demand CHO: Community Health Organisation
  • 12. SIGSIMPADS 2016 Study Limitations • Only public acute hospitals were considered, from which the IHFD records were obtained. • The records of the IHFD dataset did not evenly represent the 9 CHOs. • The real data obtained by the study covered only a single year, which was 2013. • The rate of hip fractures was assumed as a constant over the simulated interval, however it might increase or decrease in reality. 12
  • 13. SIGSIMPADS 2016 Discussion: The Role of Machine Learning 13
  • 14. SIGSIMPADS 2016 Discussion: The Role of Machine Learning (cont’d) 14
  • 15. SIGSIMPADS 2016 Summary • The developed model can realise a population-based perspective for care delivery of hip fracture care in particular. • The combined approach of simulation modeling and ML is claimed to increase the simulation model accuracy. • Further, the model can further serve as a surrogate model for expecting the potential demand for elderly care in general. 15
  • 16. SIGSIMPADS 2016 Acknowledgements • PhD Supervisor: Owen Molloy. • National Office of Clinical Audit (NOCA), Ireland. • SIGSIM PADS. • The reviewers of our paper. 16
  • 17. SIGSIMPADS 2016 THANK YOU! Mahmoud Elbattah m.elbattah1@nuigalway.ie