A simulation-based modeling framework to deal with Clinical Pathways

In this paper we focus our attention on the analysis and management of Clinical Pathways (CPs) in health care systems. From an operational point of view, the CP is “the path” followed by a patient with a given pathology through the health-care system. We start by a global vision and propose a modeling framework based on a discrete event simulation model to identify the critical activities and scarce resources that represent the process bottlenecks both from a patient-centered and facility-centered point of view. Moreover, we face the challenging problem of integrating simulation and optimization in order to put together the capability of the simulation in the scenario analysis (“what-if” analysis) and in describing the dynamics of the system considered and the decisional strength of the optimization, i.e., the “what-best” analysis. The framework is applied to a case study for the thyroid surgical treatment.