Qingxia Kong - Academia.edu (original) (raw)

Papers by Qingxia Kong

JMIR Human Factors, 2021

Background The COVID-19 pandemic has impacted the capacity of the regular health care system, whi... more Background The COVID-19 pandemic has impacted the capacity of the regular health care system, which is reflected in limited access to nonurgent care for patients who are chronically ill in the Dutch health care system. Nevertheless, many of them still depend on health care assistance to manage their illnesses. Patient portals are used to provide continued health care (remotely) and offer self-management tools during COVID-19 and potentially after. However, little is known about the factors influencing portal use and users’ satisfaction among patients who are chronically ill during the COVID-19 pandemic. Objective This study aims to examine predictors of patient portal use among patients who are chronically ill, the willingness to recommend the portal to others, and the likelihood of future use among portal nonusers. Methods An online self-administered questionnaire was distributed among patients who are chronically ill via social media in May 2020. The questionnaire consisted of fou...

textabstractThis paper studies an appointment scheduling problem under schedule-dependent patient... more textabstractThis paper studies an appointment scheduling problem under schedule-dependent patient no-show behavior. The problem is motivated by our studies of independent datasets from countries in two continents which identify a significant time-of-day effect on patient show-up probabilities. We deploy a distributionally robust model, which minimizes the worst case total expected cost of patient waiting and service provider's idle and overtime, by optimizing the scheduled arrival times of patients. We show that this model under schedule-independent patient show-up behavior can be reformulated as a copositive program and then be approximated by semidefinite programs. These formulations are obtained by a new technique that uses a completely positive program to equivalently represent a linear program with uncertainties present in both the objective function and the right-hand side of the constraint sets. To tackle the case when patient no-shows are endogenous on the schedule, we c...

Visualizing knowledge evolution trends and research hotspots of personal health data research: a bibliometric review (Preprint)

JMIR Medical Informatics

PLOS ONE

Objective In China, patients increasingly choose to access already severely overcrowded higher le... more Objective In China, patients increasingly choose to access already severely overcrowded higher level hospitals, leaving lower level facilities with low utilization rates. This situation undermines the effectiveness and efficiency of the health system. The situation tends to worsen despite policy measures aimed at improvement. We systematically review the factors affecting patient choice to synthesize scientific understanding of health system access in China. The review provides an evidence base for measures to direct patient flow towards lower level facilities. Methods We screened the peer-reviewed literature published from April 2009 to January 2016 that investigates Chinese patients' choice of health care facilities at different levels and assessed 45 studies in total. We applied two structured forms to extract data on each study's characteristics, methodology, and factors. Results of data synthesis The results identified four factor types: 1) patient, 2) provider, 3) context and 4) composite: combined patient, provider, and/or context attributes. Patient factors are mentioned the most, but the evidence on patient factors is often inconclusive. Evidence suggests that the provider factors 'drug variety' and 'equipment', and composite factor 'perceived quality', push patients from lower levels towards higher levels. Conclusion Underuse of primary care facilities and overcrowding of higher level facilities will likely be amplified by current demographic trends. Evidence suggests that improving drug availability, equipment and perceived quality of primary care services can improve the situation. Well-designed research that considers the interactions between factors is called for to better inform future interventions.

Appointment Scheduling Under Time-Dependent Patient No-Show Behavior

Management Science

This paper studies how to schedule medical appointments with time-dependent patient no-show behav... more This paper studies how to schedule medical appointments with time-dependent patient no-show behavior and random service times. The problem is motivated by our studies of independent datasets from countries in two continents that unanimously identify a significant time-of-day effect on patient show-up probabilities. We deploy a distributionally robust model, which minimizes the worst-case total expected costs of patient waiting and service provider’s idling and overtime, by optimizing the scheduled arrival times of patients. This model is challenging because evaluating the total cost for a given schedule involves a linear program with uncertainties present in both the objective function and the right-hand side of the constraints. In addition, the ambiguity set considered contains discrete uncertainties and complementary functional relationships among these uncertainties (namely, patient no-shows and service durations). We show that when patient no-shows are exogenous (i.e., time-inde...

SSRN Electronic Journal

We demonstrate that lottery markets can exhibit the "hot-hand" phenomenon, in which past winning ... more We demonstrate that lottery markets can exhibit the "hot-hand" phenomenon, in which past winning numbers tend to receive a greater share of the bets in future draws, even though past and future events are independent. This finding is surprising, as works by Clotfelter and Cook (1993) and Terrell (1994) have previously documented the presence of an opposite effect-the "gambler's fallacy"-in the U.S. lottery market. The current literature also suggests that the gambler's fallacy prevails when random numbers are generated by mechanical devices, such as in lottery games (Ayton and Fisher 2004, Burns and Corpus 2004, Caruso et al. 2010). We use two sets of naturally occurring data to show that both the gambler's fallacy and the hot-hand fallacy can exist in different types of lottery games. We then run online experimental studies that mimic lottery games with one, two, or three winning numbers. Our experimental results show that the number of winning prizes impacts behavior. In particular, whereas a single-prize game leads to a strong presence of the gambler's fallacy, we observe a significant increase in hot-hand behavior in multiple-prize games with two or three winning numbers.

Social Science & Medicine

To successfully tackle the problems with the underutilization of primary care in rural China, it ... more To successfully tackle the problems with the underutilization of primary care in rural China, it is important to align resource allocation with the preferences of the rural population. However, despite growing interest in the factors influencing the rural population's choice of facility, it is unclear how much weight should be placed on these factors, especially under different scenarios of disease severity. In the first study to elicit quantified trade-offs among influential factors in choosing health care facilities, we carried out a discrete choice experiment (DCE) in rural China. We used a Bayesian efficient design to construct 36 choice sets, and then divided them into three blocks. Each block formed one version of questionnaire that contained 12 choice questions. Each question was assigned a hypothetical perceived severity scenario of either minor or severe disease. 559 Rural residents completed the DCE through faceto-face interviews in December 2017-March 2018. We used mixed logit models to analyze the choice data. The factors regarding the availability and affordability of a facility, such as visit time, travel time, and out-of-pocket cost, were highly valued. When the facilities changed simultaneously from the worst to the best case, a huge increase (from 4.8% to 66.5%) in the predicted choice probability of choosing to visit a facility was observed under perceived minor disease scenario, whereas there was no significant change under perceived severe disease scenario. Improvements to drug availability, medical professional skill and equipment in rural primary care system can induce potential medical care seeking, and redirect patient flow from higher level hospitals to primary level. Especially, township health centers, which provide service to the residents in rural communities, have great potential to be the ideal facilities for first-contact care.

Revista de saude publica, Jan 5, 2018

Chile has lower breast cancer incidence rates compared to those in developed countries. Our publi... more Chile has lower breast cancer incidence rates compared to those in developed countries. Our public health system aims to perform 10 biennial screening mammograms in the age group of 50 to 69 years by 2020. Using a dynamic programming model, we have found the optimal ages to perform 10 screening mammograms that lead to the lowest lifetime death rate and we have evaluated a set of fixed inter-screening interval policies. The optimal ages for the 10 mammograms are 43, 47, 51, 54, 57, 61, 65, 68, 72, and 76 years, and the most effective fixed inter-screening is every four years after the 40 years. Both policies respectively reduce lifetime death rate in 6.4% and 5.7% and the cost of saving one life in 17% and 9.3% compared to the 2020 Chilean policy. Our findings show that two-year inter-screening interval policies are less effective in countries with lower breast cancer incidence; thus we recommend screening policies with a wider age range and larger inter-screening intervals for Chile.

Appointment sequencing: Why the Smallest-Variance-First rule may not be optimal

European Journal of Operational Research, 2016

Optimal Guidelines for Screening Mammography Based on Individual Risk Factors

SSRN Electronic Journal, 2000

Chapter Fifteen. Managing Risk in Numbers Games

Theory and Applications, 2015

Journal of Gambling Studies, 2009

In fixed-odds numbers games, the prizes and the odds of winning are known at the time of placemen... more In fixed-odds numbers games, the prizes and the odds of winning are known at the time of placement of the wager. Both players and operators are subject to the vagaries of luck in such games. Most game operators limit their liability exposure by imposing a sales limit on the bets received for each bet type, at the risk of losing the rejected bets to the underground operators. This raises a question-how should the game operator set the appropriate sales limit? We argue that the choice of the sales limit is intimately related to the ways players select numbers to bet on in the games. There are ample empirical evidence suggesting that players do not choose all numbers with equal probability, but have a tendency to bet on (small) numbers that are closely related to events around them (e.g., birth dates, addresses, etc.). To the best of our knowledge, this is the first paper to quantify this phenomenon and examine its relation to the classical Benford's law. We use this connection to develop a choice model, and propose a method to set the appropriate sales limit in these games.

In this paper, we investigate a stochastic appointment scheduling problem in an outpatient clinic... more In this paper, we investigate a stochastic appointment scheduling problem in an outpatient clinic with a single doctor. The number of patients and their sequence of arrivals are fixed, and the scheduling problem is to determine an appointment time for each patient. The service durations of the patients are stochastic, and only the mean and covariance estimates are known. We do not assume any exact distributional form of the service durations, and solve for distributionally robust schedules that minimize the expectation of the weighted sum of patients' waiting time and doctor's overtime. We formulate this scheduling problem as a convex conic optimization problem with a tractable semidefinite relaxation. Our model can be extended to handle additional support constraints of the service durations. Using the primal-dual optimality conditions, we prove several interesting structural properties of the optimal schedules. We develop an efficient semidefinite relaxation of the conic program, and show that we can still obtain near optimal solutions on benchmark instances in the existing literature. We apply our approach to develop a practical appointment schedule at an eye clinic that can significantly improve the efficiency of the appointment system in the clinic, compared to an existing schedule.