Advertisement

Using Markov Systems to Plan Stroke Services

  • Sally McClean
  • Lalit Garg
  • Maria Barton
  • Ken Fullerton
  • Peter Millard
Part of the Studies in Computational Intelligence book series (SCI, volume 189)

Abstract

We have previously used Markov models to describe movements of patients between hospital states. The distribution of costs at any time and in a given time interval were also previously evaluated and expressions found for the corresponding means and variances. In this paper we extend our previous model to a system that includes on-off costs of making a transition from one state to another; previously costs were per day for the appropriate state. Such transition costs allow us to evaluate the overall costs of therapy or a clinical intervention where an operation or other intervention may be an option. This model can be used to determine costs for the entire system for different strategies thus facilitating a systems approach to the planning of healthcare and a holistic approach to costing. Such models can also help us to assess the complex relationship between hospital and community care where there may be possible trade-offs between hospital treatment costs and community care costs. Such a scenario is commonly encountered in stroke disease where care may include a long period of rehabilitation or residence in a nursing home.

Keywords

Markov systems Stroke services Markov decision models 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Chambers, M.G., Koch, P., Hutton, J.: Development of a decision analytic model of stroke care in the United States and in Europe. Value in Health 5(2), 82–87 (2002)CrossRefGoogle Scholar
  2. 2.
    Curtis, L.: Unit costs of health and social care: Personal Social Services Research Unit (PSSRU), University of Kent, Canterbury (2007)Google Scholar
  3. 3.
    Ehlers, L., Anderson, G., Clauson, G.S.: Cost-effectiveness of intravenous thrombolysis with altephase within a 3 hour window after ischemic stroke. Stroke 38, 85–89 (2007)CrossRefGoogle Scholar
  4. 4.
    Faddy, M.J., McClean, S.I.: Markov Chain Modelling for Geriatric Patient Care. Methods of Information in Medicine 44(3), 369–373 (2005)Google Scholar
  5. 5.
    Fagan, S., Morgenson, L., Petitta, A., Ward, R.E., Tilley, B.C., Marler, J.R., Levine, S.R., Broderick, J.P., Kwiatkowski, T.G., Frankel, M., Brott, T.G., Walker, M.D.: The NINDS rt-PA Stroke Study Group: Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke. Neurology 50, 883–890 (1998)Google Scholar
  6. 6.
    Field, M.C., Levine, S.R.: Clot-busting therapy helps stroke victims – but only if they get treatment in time. Neur. 64, E1–E2 (2005)Google Scholar
  7. 7.
    García-Moncó, J.C., Pinedo, A., Escalza, I., Ferreira, E., Foncea, N., Gómez-Beldarrain, M., Ruiz-Ojeda, J., Mateo, I., Mediavilla, J., Basterretxea, J.M.: Analysis of the reasons for the exclusion of tpa therapy after early arrival in hospital. Clinical Neurol. Neurosurg. (August 2006)Google Scholar
  8. 8.
    Hacke, W., Kaste, M., Fieschi, C.: Intravenous thrombolysis with recumbent tissue activator for acute hemi-spheric stroke. The European Acute Stroke Study (ECASS), JAMA 274, 1017–1022 (1995) Google Scholar
  9. 9.
    Jorgenson, H., Nakayama, H., Raaschou, H.: The effect of a stroke unit: Reduction in mortality, discharge rates to nursing homes, length of stay and cost – A community based study. Stroke 26, 1178–1182 (1995)Google Scholar
  10. 10.
    Leibson, C.: Stroke attributable nursing home use. A population based study. Neurology 51, 163–168 (1998)Google Scholar
  11. 11.
    McClean, S.I., Millard, P.H.: Where to Treat the Older Patient? Can Markov Models Help us Better Understand the Relationship between Hospital and Community Care? Journal of the Operational Research Society 58(2), 255–261 (2006)Google Scholar
  12. 12.
    McClean, S.I., Papadopoulou, A., Tsaklidis, G., Garg, L., Barton, M., Millard, P.: Evaluating strategies using non-homogeneous Markov and semi-Markov Systems. In: International Workshop on Applied Probability, Compiègne, France, July 7-10 (2008)Google Scholar
  13. 13.
    Marshall, A.H., McClean, S.I., Shapcott, C.M., Millard, P.H.: Learning dynamic bayesian belief networks using conditional phase-type distributions. In: Zighed, D.A., Komorowski, J., Żytkow, J.M. (eds.) PKDD 2000. LNCS, vol. 1910, pp. 516–523. Springer, Heidelberg (2000)CrossRefGoogle Scholar
  14. 14.
    National Audit Office: Reducing brain damage: Faster access to better stroke care. Report by the controller and audit general, NAO. London (2005)Google Scholar
  15. 15.
    National Institute for Clinical Excellence (NICE): Final Appraisal Determination: Drugs for early thrombolysis in treatment of acute myocardial infarction. London, UK, National Institute for Clinical Excellence (2002)Google Scholar
  16. 16.
    National Institute of Neurological Disorders and Stroke (NINDS) and Tissue Plasiminogen activator (tpa) Stroke Study Group: Tissue plasminogen activator for acute stroke. New England Journal of Medicine 333(24), 1581–1587 (1995)Google Scholar
  17. 17.
    Sandercock, P., Berge, E., Dennis, M., Forbes, J., Hand, P., Kwan, J., Lewis, S., Neilson, A., Wardlaw, J.: Cost-effectiveness of thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke assessed by a model based on UK NHS costs. Stroke 35, 1490–1498 (2004)CrossRefGoogle Scholar
  18. 18.
    Stahl, J.E., Furie, K.L., Gleason, S., Gazelle, G.S.: Stroke: Effect of implementing an evaluation and treatment protocol compliant with NINDS recommendations. Radiology 228, 659–668 (2003)CrossRefGoogle Scholar
  19. 19.
    Sundberg, G., Bagust, A., Terent, A.: A model for costs of stroke services. Health Policy 63, 81–94 (1993)CrossRefGoogle Scholar
  20. 20.
    Taylor, W.J., Wong, A., Siegert, R.J., McNaughton, H.K.: Effectiveness of a clinical pathway for acute stroke care in a district general hospital: an audit. BMC Health Services Research, BioMed. Central, 1–7 (2006)Google Scholar
  21. 21.
    Wardlaw, J.M., Zoppo, G., Yamaguchi, T., Berge, E.: Thrombolysis for acute ischemic stroke (Cochrane Review). The Cochrane Library. Cochrane Database System Rev. 3. Oxford (1993)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Authors and Affiliations

  • Sally McClean
    • 1
  • Lalit Garg
    • 1
  • Maria Barton
    • 1
  • Ken Fullerton
    • 2
  • Peter Millard
    • 3
  1. 1.School of Computing and Information EngineeringUniversity of UlsterUK
  2. 2.Queen’s UniversityBelfastUK
  3. 3.St. George’s University of LondonUK

Personalised recommendations