Hospitals commonly project demand for their services by combining their historical share of regional demand with forecasts of total regional demand. Hospital-specific forecasts of demand that provide prediction intervals, rather than point estimates, may facilitate better managerial decisions, especially when demand overage and underage are associated with high, asymmetric costs. Regional forecasts of patient demand are commonly available as a Poisson random variable, e.g., for the number of people requiring hospitalization due to an epidemic such as COVID-19. However, even in this common setting, no probabilistic, consistent, computationally tractable forecast is available for the fraction of patients in a region that a particular institution should expect. We introduce such a forecast, DICE (Demand Intervals from Consistent Estimators). We describe its development and deployment at an academic medical center in California during the `second wave' of COVID-19 in the Unite States. We show that DICE is consistent under mild assumptions and suitable for use with perfect, biased, unbiased regional forecasts. We evaluate its performance on empirical data from a large academic medical center as well as on synthetic data.
Widespread vaccination campaigns have changed the landscape for COVID-19, vastly altering symptoms and reducing morbidity and mortality. We estimate trends in mortality by month of admission and vaccination status among those hospitalised with COVID-19 in England between March 2020 to September 2021, controlling for demographic factors and hospital load. Among 259,727 hospitalised COVID-19 cases, 51,948 (20.0%) experienced mortality in hospital. Hospitalised fatality risk ranged from 40.3% (95% confidence interval 39.4-41.3%) in March 2020 to 8.1% (7.2-9.0%) in June 2021. Older individuals and…
We describe the models we built for hospital admissions and occupancy of COVID-19 patients in the Netherlands. These models were used to make short-term decisions about transfers of patients between regions and for long-term policy making. We motivate and describe the model we used for predicting admissions and how we use this to make predictions on occupancy.
Understanding differences in hospital case-fatality rates (HCFRs) of coronavirus disease (COVID-19) may help evaluate its severity and the capacity of the healthcare system to reduce mortality. We examined the variability in HCFRs of COVID-19 in relation to spatial inequalities in socioeconomic factors across the city of Sao Paulo, Brazil. We found that HCFRs were higher for men and for individuals aged 60 years and older. Our models identified per capita income as a significant factor that is negatively associated with the HCFRs of COVID-19, even after adjusting by age, sex and presence of ri…
Background: Trends in hospitalised case-fatality risk (HFR), risk of intensive care unit (ICU) admission and lengths of stay for patients hospitalised for COVID-19 in England over the pre-vaccination era are unknown. Methods: Data on hospital and ICU admissions with COVID-19 at 31 NHS trusts in England were collected by Public Health England's Severe Acute Respiratory Infections surveillance system and linked to death information. We applied parametric multi-state mixture models, accounting for censored outcomes and regressing risks and times between events on month of admission, geography, an…
Demand for Personal Protective Equipment (PPE) such as surgical masks, gloves, and gowns has increased significantly since the onset of the COVID-19 pandemic. In hospital settings, both medical staff and patients are required to wear PPE. As these facilities resume regular operations, staff will be required to wear PPE at all times while additional PPE will be mandated during medical procedures. This will put increased pressure on hospitals which have had problems predicting PPE usage and sourcing its supply. To meet this challenge, we propose an approach to predict demand for PPE. Specificall…
We investigate the prevalence rate of smoking in Covid-19 patients and examine whether there is a difference in the distribution of smokers between the two statistical populations of critically ill patients with Covid-19 and the entire Iranian population or not. To do this, we first prepared a sample of 1040 Covid-19 patients admitted to hospitals in Tehran, Rasht, and Bojnord. Then, through the non-parametric statistical runs test, we show that the sample was randomly selected, and it is possible to generalize the result of tests on the sample to the community of hospitalized Covid-19 patient…
TH Köln（科隆工业大学）；Bartz und Bartz GmbH（Bartz und Bartz有限公司）
We present a resource-planning tool for hospitals under special consideration of the COVID-19 pandemic, called babsim.hospital. It provides many advantages for crisis teams, e.g., comparison with their own local planning, simulation of local events, simulation of several scenarios (worst / best case). There are benefits for medical professionals, e.g, analysis of the pandemic at local, regional, state and federal level, the consideration of special risk groups, tools for validating the length of stays and transition probabilities. Finally, there are potential advantages for administration, man…
H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, USA（佐治亚理工学院工业与系统工程学院）
As the COVID-19 spread over the globe and new variants of COVID-19 keep occurring, reliable real-time forecasts of COVID-19 hospitalizations are critical for public health decision on medical resources allocations such as ICU beds, ventilators, and personnel to prepare for the surge of COVID-19 pandemics. Inspired by the strong association between public search behavior and hospitalization admission, we extended previously-proposed influenza tracking model, ARGO (AutoRegression with GOogle search data), to predict future 2-week national and state-level COVID-19 new hospital admissions. Leverag…
The first year of the COVID-19 pandemic put considerable strain on the national healthcare system in England. In order to predict the effect of the local epidemic on hospital capacity in England, we used a variety of data streams to inform the construction and parameterisation of a hospital progression model, which was coupled to a model of the generalised epidemic. We named this model EpiBeds. Data from a partially complete patient-pathway line-list was used to provide initial estimates of the mean duration that individuals spend in the different hospital compartments. We then fitted EpiBeds …
Measuring the prevalence of active SARS-CoV-2 infections in the general population is difficult because tests are conducted on a small and non-random segment of the population. However, people admitted to the hospital for non-COVID reasons are tested at very high rates, even though they do not appear to be at elevated risk of infection. This sub-population may provide valuable evidence on prevalence in the general population. We estimate upper and lower bounds on the prevalence of the virus in the general population and the population of non-COVID hospital patients under weak assumptions on wh…
For hospitals, realistic forecasting of bed demand during impending epidemics of infectious diseases is essential to avoid being overwhelmed by a potential sudden increase in the number of admitted patients. Short-term forecasting can aid hospitals in adjusting their planning and freeing up beds in time. We created an easy-to-use online on-request tool based on local data to forecast COVID-19 bed demand for individual hospitals. The tool is flexible and adaptable to different settings. It is based on a stochastic compartmental model for estimating the epidemic dynamics and coupled with an expo…
Objective: To evaluate the relationship between coronavirus disease 2019 (COVID-19) diagnosis with SARS-CoV-2 variant B.1.1.7 (also known as Variant of Concern 202012/01) and the risk of hospitalisation compared to diagnosis with wildtype SARS-CoV-2 variants. Design: Retrospective cohort, analysed using stratified Cox regression. Setting: Community-based SARS-CoV-2 testing in England, individually linked with hospitalisation data. Participants: 839,278 laboratory-confirmed COVID-19 patients, of whom 36,233 had been hospitalised within 14 days, tested between 23rd November 2020 and 31st January…
Coronavirus disease (COVID-19) is a severe ongoing novel pandemic that has emerged in Wuhan, China, in December 2019. As of October 13, the outbreak has spread rapidly across the world, affecting over 38 million people, and causing over 1 million deaths. In this article, I analysed several time series forecasting methods to predict the spread of COVID-19 second wave in Italy, over the period after October 13, 2020. I used an autoregressive model (ARIMA), an exponential smoothing state space model (ETS), a neural network autoregression model (NNAR), and the following hybrid combinations of them…
We propose the SH model, a simplified version of the well-known SIR compartmental model of infectious diseases. With optimized parameters and initial conditions, this time-invariant two-parameter two-dimensional model is able to fit COVID-19 hospitalization data over several months with high accuracy (e.g., the root relative squared error is below 10% for Belgium over the period from 2020-03-15 to 2020-07-15). Moreover, we observed that, when the model is trained on a suitable three-week period around the first hospitalization peak for Belgium, it forecasts the subsequent two months with mean …
A key issue for all observational causal inference is that it relies on an unverifiable assumption - that observed characteristics are sufficient to proxy for treatment confounding. In this paper we argue that in medical cases these conditions are more likely to be met in cases where standardized treatment guidelines do not yet exist. One example of such a situation is the emergence of a novel disease. We study the case of early COVID-19 in New York City hospitals and show that observational analysis of two important thereapeutics, anti-coagulation and steroid therapy, gives results that agree…
Since the COVID-19 pandemic first reached the United States, the case fatality rate has fallen precipitously. Several possible explanations have been floated, including greater detection of mild cases due to expanded testing, shifts in age distribution among the infected, lags between confirmed cases and reported deaths, improvements in treatment, mutations in the virus, and decreased viral load as a result of mask-wearing. Using both Florida line-level data and recently released (but incomplete) national line level data from April 1, 2020 to November 1, 2020 on cases, hospitalizations, and de…
Tufts University（塔夫茨大学）；Tufts Medical Center（塔夫茨医疗中心）
We address the problem of modeling constrained hospital resources in the midst of the COVID-19 pandemic in order to inform decision-makers of future demand and assess the societal value of possible interventions. For broad applicability, we focus on the common yet challenging scenario where patient-level data for a region of interest are not available. Instead, given daily admissions counts, we model aggregated counts of observed resource use, such as the number of patients in the general ward, in the intensive care unit, or on a ventilator. In order to explain how individual patient trajector…
University of Texas Health Science Center at Houston（德克萨斯大学休斯顿健康科学中心）；McGovern Medical School of The University of Texas Health Science Center at Houston（德克萨斯大学休斯顿健康科学中心麦戈文医学院）
We propose a robust in-time predictor for in-hospital COVID-19 patient's probability of requiring mechanical ventilation. A challenge in the risk prediction for COVID-19 patients lies in the great variability and irregular sampling of patient's vitals and labs observed in the clinical setting. Existing methods have strong limitations in handling time-dependent features' complex dynamics, either oversimplifying temporal data with summary statistics that lose information or over-engineering features that lead to less robust outcomes. We propose a novel in-time risk trajectory predictive model to…
The COVID-19 pandemic has created unprecedented challenges worldwide. Strained healthcare providers make difficult decisions on patient triage, treatment and care management on a daily basis. Policy makers have imposed social distancing measures to slow the disease, at a steep economic price. We design analytical tools to support these decisions and combat the pandemic. Specifically, we propose a comprehensive data-driven approach to understand the clinical characteristics of COVID-19, predict its mortality, forecast its evolution, and ultimately alleviate its impact. By leveraging cohort-leve…
