Applying patient-admission predictive algorithms in the South African healthcare system

[摘要] ENGLISH ABSTRACT: Predictive analytics in healthcare has become one of the major focus areas in healthcare delivery worldwide. Due to the massive amount of healthcare data being captured, healthcare providers and health insurers are investing in predictive analytics and its enabling technologies to provide valuable insight into a large variety of healthcare outcomes. One of the latest developments in the field of healthcare predictive modelling (PM) was the launch of the Heritage Health Prize; a competition that challenges individuals from across the world to develop a predictive model that successfully identifies the patients at risk of admission to hospital from a given patient population. The patient-admission predictive algorithm (PAPA) is aimed at reducing the number of unnecessary hospitalisations that needlessly constrain healthcare service delivery worldwide.The aim of the research presented is to determine the feasibility and value of applying PAPAs in the South African healthcare system as part of a preventive care intervention strategy. A preventive care intervention strategy is a term used to describe an out-patient hospital service, aimed at providing preventive care in an effort to avoid unnecessary hospitalisations from occurring.The thesis utilises quantitative and qualitative techniques. This included a review of the current and historic PM applications in healthcare to determine the major expected shortfalls and barriers to implementation of PAPAs, as well as the institutional and operational requirements of these predictive algorithms. The literature study is concluded with a review of the current state of affairs in the South African healthcare system to, firstly, articulate the need for PAPAs and, secondly, to determine whether the public and private sectors provide a suitable platform for implementation (evaluated based on the operational and institutional requirements of PAPAs). Furthermore, a methodology to measure and analyse the potential value-add of a PAPA care intervention strategy was designed and developed. The methodology required a survey of the industry leaders in the private healthcare sector of South Africa to identify, firstly, the current performance foci and, secondly, the factors that compromise the performance of these organisations to deliver high quality, resource-effective care. A quantitative model was developed and applied to an industry leader in the private healthcare sector of South Africa, in order to gauge the resultant impact of a PAPA care intervention strategy on healthcare provider performance. Lastly, in an effort to ensure the seamless implementation and operation of PAPAs, an implementation framework was developed to address the strategic, tactical, and operational challenges of applying predictive analytics and preventive care strategies similar to PAPAs. The research found that the application of PAPAs in the public healthcare sector of South Africa is infeasible. The private healthcare sector, however, was considered a suitable platform to implement PAPAs, as this sector satisfies the institutional and operational requirements of PAPAs. The value-add model found that a PAPA intervention strategy will add significant value to the performance of healthcare providers in the private healthcare sector of South Africa. Noteworthy improvements are expected in the ability of healthcare provider's to coordinate patient care, patient-practitioner relationships, inventory service levels, and staffing level efficiency and effectiveness. A slight decrease in the financial operating margin, however, was documented. The value-add methodology and implementation support framework provides a suitable platform for future researchers to explore the collaboration of preventive care and PM in an effort to improve healthcare resource management in hospitals. In conclusion, patient-admission predictive algorithms provide improved evidence-based decision making for preventive care intervention strategies. An efficient and effective preventive care intervention strategy improves healthcare provider performance and, therefore, adds significant value to these organisations. With the proper planning and implementation support, the application of PAPA care intervention strategies will change the way healthcare is delivered worldwide.

[发布机构] Stellenbosch University