A novel VIKOR method with an application to multiple criteria decision analysis for hospital-based post-acute care within a highly complex uncertain environment

摘要

Post-acute care (PAC) is an interdisciplinary healthcare service used to assist in returning patients to their community after they receive acute medical services. To establish a fully developed PAC service model, the National Health Insurance Administration in Taiwan attempts to recruit professional medical service institutions (consisting of medical centers and regional and district hospitals) in a trial program for improving the rehabilitation quality of patients with cerebrovascular diseases (CVDs) and to reduce the re-hospitalization rate. The evaluation and selection of adequate medical service institutions are critical in the program for enhancing the effectiveness of hospital-based PAC in acute stroke management. However, because of the complexity of the national health insurance system and the healthcare system in Taiwan, the determination of pilot hospitals is a highly complicated and ambiguous multiple criteria decision analysis (MCDA) problem. Focusing on the requirement of generating a set of pilot hospitals for the PAC program and tackling imprecise and uncertain information associated with a complex medical circumstance, the purpose of this paper is to develop a novel compromising decision-making method based on the interval-valued Pythagorean fuzzy (IVPF) set theory and the VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR) methodology to address the multiple criteria selection problem of pilot hospitals in assisting the establishment of a hospital-based PAC model. Considering the powerfulness of IVPF sets when handling vagueness and complex uncertainty in practical problems, this paper proposes a useful IVPF VIKOR method that is significantly different from the existing VIKOR methodology. The proposed methodology represents a comprehensive integration of high-order uncertainties within a decision environment into the basic VIKOR structure that is designed to lead to both better description and better applicability of MCDA. This paper presents some novel concepts such as remoteness indices and remoteness-based multiple criteria ranking indices and investigates their desirable properties in detail. With the theoretical support of these new concepts, this paper establishes useful remoteness-based group utility indices, individual regret indices, and compromise indices for the assessment of acceptable advantage and acceptable stability. Unlike the current VIKOR-based ranking process, this paper provides a systematic ranking procedure that is capable of improving the efficiency of determining ultimate compromise solutions. Overall, the present study provides several significant contributions, such as structuring the selection problem for hospital-based PAC, extending the IVPF theory and VIKOR to the medical and healthcare fields, simplifying the manipulation procedure in handling IVPF information, constructing valuable concepts of remoteness-based indices, and developing an effective IVPF VIKOR ranking procedure. A real-world example of selecting pilot hospitals in the PAC program for CVDs is provided to illustrate the application of the proposed method and to demonstrate its practicality and effectiveness. Furthermore, other valuable MCDA applications with a comparative analysis are conducted to validate the advantages of the proposed method in a variety of fields.