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Optimal control of healthcare-associ...

Codella, James V.

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Optimal control of healthcare-associated C. difficile infection.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Optimal control of healthcare-associated C. difficile infection./
作者:	Codella, James V.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2014,
面頁冊數:	167 p.
附註:	Source: Dissertations Abstracts International, Volume: 77-05, Section: B.
Contained By:	Dissertations Abstracts International77-05B.
標題:	Industrial engineering. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3734747
ISBN:	9781339234243

Optimal control of healthcare-associated C. difficile infection.
Codella, James V.

Optimal control of healthcare-associated C. difficile infection. - Ann Arbor : ProQuest Dissertations & Theses, 2014 - 167 p.

Source: Dissertations Abstracts International, Volume: 77-05, Section: B.

Thesis (Ph.D.)--The University of Wisconsin - Madison, 2014.

This item must not be sold to any third party vendors.

Clostridium difficile Infection (CDI) is one of the most prevalent healthcare-associated infections. The current guidelines to reduce CDI transmission contain several recommendations of interventions. However, these guidelines do not consider obstacles such as low adherence to interventions, limited budget for infection control, or the disutility a patient may experience from an intervention. This dissertation focuses on developing models to help infection control specialists in reducing the transmission of CDI in a hospital. The first part of this dissertation is the description of the agent-based simulation model that evaluates CDI transmission and control in a hospital. The agents we consider are patients, HCWs, and visitors. The agents interact with each other and with the hospital environment and interactions with patients with CDI or asymptomatic colonization can lead to the propagation of CDI in the hospital. Our model examines the effects of four intervention strategies on CDI transmission: oral vancomycin for the treatment of CDI, bleach disinfection of CDI+ patient rooms, increased hand-hygiene measures for healthcare workers (HCWs), and placing CDI+ patients in contact isolation. The parameters are estimated via clinical data, published literature, and calibration. This model identifies the most effective single-strategies to reduce CDI in the hospital. When cost data is introduced, we determine the clinical and financial implications of low adherence CDI interventions. The second part of this dissertation addresses the problem of optimal control of CDI in a hospital while minimizing the total expected health disutility of patients. We develop a constrained infinite-horizon continuous-time Markov decision process (MDP) that we solve optimally. This model produces optimal mixed-strategy polices dependent on the number of susceptible, asymptomatically colonized, and infected patients in the hospital. We determine the effects of limited budgets on CDI control, and limited adherence to particular CDI interventions. Furthermore, we compare multiple objectives to determine the effect of varying goals on reducing CDI in the hospital, optimal policy, and total expected patient disutility. We show that the objective of minimizing the total number of CDIs can lead to unnecessary patient disutility.

ISBN: 9781339234243Subjects--Topical Terms:

526216
Industrial engineering.

Optimal control of healthcare-associated C. difficile infection.
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