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In order to improve the standard of management in hospitals and effectively control the cost of clinical treatments, this research primarily focuses on optimizing the scheduling of clinical pathways (CPs). A mathematical model for CP scheduling is constructed, and the hybrid genetic algorithm (HGA, combining a genetic algorithm with particle swarm optimization) is proposed for solving this problem so as to distribute medical resources and schedule the treatments of patients reasonably and effectively. The optimal search space can be further enlarged by introducing a new mutation mechanism, which allows a more satisfactory solution to be found. In particular, the relative patient waiting time and relative time efficiency are used as measure indexes, which are more scientific and effective than the usual indexes of absolute time and absolute time efficiency. After comparing absolute waiting time, relative waiting time, utilization of absolute waiting time, and utilization of relative waiting time waiting respectively, the conclusion can confidently be drawn that task scheduling obviously enhances patients' time efficiency, reduces time wastage and therefore promotes patient satisfaction with medical processes. Moreover, the patients can to a certain degree move away from their usual passive role in medical processes by using this scheduling system. In order to further validate the rationality and validity of the proposed method, the heuristic rules for CP scheduling are also tested using the same case. The results demonstrate that the proposed HGA achieves superior performance, in terms of precision, over those heuristic rules for CP scheduling. Therefore, we utilize HGA to optimize CP scheduling, thus providing a decision-making mechanism for medical staff and enhancing the efficiency of medical processes. This research has both theoretical and practical significance for electronic CP management, in particular.

Clinical pathways' variances present complex, fuzzy, uncertain and high-risk characteristics. They could cause complicating diseases or even endanger patients' life if not handled effectively. In order to improve the accuracy and efficiency of variances handling by Takagi-Sugeno (T-S) fuzzy neural networks (FNNs), a new variances handling method for clinical pathways (CPs) is proposed in this study, which is based on T-S FNNs with novel hybrid learning algorithm. And the optimal structure and parameters can be achieved simultaneously by integrating the random cooperative decomposing particle swarm optimization algorithm (RCDPSO) and discrete binary version of PSO (DPSO) algorithm. Finally, a case study on liver poisoning of osteosarcoma preoperative chemotherapy CP is used to validate the proposed method. The result demonstrates that T-S FNNs based on the proposed algorithm achieves superior performances in efficiency, precision, and generalization ability to standard T-S FNNs, Mamdani FNNs and T-S FNNs based on other algorithms (CPSO and PSO) for variances handling of CPs.

Although the clinical pathway (CP) predefines predictable standardized care process for a particular diagnosis or procedure, many variances may still unavoidably occur. Some key index parameters have strong relationship with variances handling measures of CP. In real world, these problems are highly nonlinear in nature so that it's hard to develop a comprehensive mathematic model. In this paper, a rule extraction approach based on combing hybrid genetic double multi-group cooperative particle swarm optimization algorithm (PSO) and discrete PSO algorithm (named HGDMCPSO/DPSO) is developed to discovery the previously unknown and potentially complicated nonlinear relationship between key parameters and variances handling measures of CP. Then these extracted rules can provide abnormal variances handling warning for medical professionals. Three numerical experiments on Iris of UCI data sets, Wisconsin breast cancer data sets and CP variances data sets of osteosarcoma preoperative chemotherapy are used to validate the proposed method. When compared with the previous researches, the proposed rule extraction algorithm can obtain the high prediction accuracy, less computing time, more stability and easily comprehended by users, thus it is an effective knowledge extraction tool for CP variances handling.

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Variance management is important for computerized implementation of clinical pathways (CPs) to dynamically execute patient care processes and effectively provide high quality and efficient healthcare services. However, current related efforts are not adequate to support variance handling process involving two decision strategies, imprecise knowledge and the interaction with standardized CP workflow. This paper presents a knowledge-based variance management system that is developed using object-oriented analysis and design techniques, especially unified modeling language (UML), and implements effective analysis and handling of various variances through the construction and fuzzy reasoning of generalized fuzzy ECA (GFECA) rules and typed fuzzy Petri net extended by process knowledge (TFPN-PK) models related to the clinical pathway ontology and healthcare domain ontology.

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