"We wanted to improve an
overloaded system, and make it
sustainable in the long run," said
Dean Frank Chen.
The project focused on hospital
resource planning, and was driven
by healthcare data analytics and
business services innovation, with
a focus on quality-and-efficiency
driven strategies and systemsoriented
solutions.
"The Hong Kong public healthcare
system is frequently functioning
above 100% capacity. To help alleviate overcrowding, we
developed algorithms to identify
elderly patients at high risk of rehospitalisation
and then plan for
more effective post-discharge care."
"We also wanted to explore how
Public-Private Partnerships might
provide long-term solutions to
ease long wait-times in public
hospitals and clinics," said
Professor Chen.
Delivering 21st Century Healthcare,
CityU's Theme-based Research
Scheme and the first for the
College of Business, was organised
in collaboration with the Chinese
University of Hong Kong's Jockey
Club School of Public Health and
Primary Care, Columbia University in
the USA and others, and was funded
by the Research Grants Council.
The project started in November
2014 and completed recently with
substantial achievements: over 115
publications in reputable, referred journals, and the training of around
50 PhD and a dozen masters'
students. Research outputs included
the applications of data science
and artificial intelligence to identify
target elderly patient segments for
two areas: firstly, the most effective
and affordable post-discharge
care portfolios in the community.
Secondly, to predict the onset
of chronic diseases. The project
also worked on the development
of sensor technology for health
monitoring of the elderly, and in
management with scientific tools
for hospital resource planning.
Project team members included
Co-Principal Investigators Professor
Eliza Wong, and Professor Engkiong
Yeoh at School of Public
Health and Primary Care of the
Chinese University of Hong Kong;
Professor David Yao at Columbia
University; Professor Hengqing Ye
at Polytechnic University of Hong
Kong; Professor George Huang at
the University of Hong Kong; and Professor Houmin Yan, Professor
Kwok-leung Tsui, and Professor
Kwai-sang Chin at City University of
Hong Kong. Also, Co-Investigators
Dr Eman Leung at the Chinese
University of Hong Kong; Dr
Qingpeng Zhang; Professor David
ZLi; Professor Pengfei Guo; Dr Carrie
Lin; Dr Yimin Yu at City University of
Hong Kong; and Dr Calvin Or at the
University of Hong Kong.
Five main impacts on Hong
Kong's healthcare
Delivering 21st Century Healthcare
in Hong Kong has delivered on
multiple fronts. Here are five main
quality-and-efficiency impacts:
#1 Reducing emergency
admissions
The team piloted a project at a
large public hospital, in which they
implemented a machine learning
tool to identify elderly patients at
high risk of re-hospitalisation and
then plan for their more effective
post-discharge care. Predicting the
arrivals and managing patient flows
are essential to hospitals. In the
vital area of emergency healthcare
management, the project has
informed the deployment of
transitional nursing care using
predictive analytics to reduce
emergency admissions.
#2 Improving efficiency of
key hospital resources
The planning and management of
patient flow is key to the efficient use
of hospital resources. The team was
invited to provide consultation to the
development of the new Chinese
University of Hong Kong Medical
Centre on patient flow, operational
planning, and physical design to
maximise patient-centred care. They
also advised on location decision for
key diagnostics equipment in another
new public hospital, on stocking
locations and facility selection for
consumable items, porter dispatch
policies, and linear operations
strategy, and to develop an
appointment system for ambulatory
care at a major public hospital.
#3 Unlocking spare capacity
in the private sector
In 2018-19, the Hong Kong
Government decided to set up
District Health Centres (DHCs) in
all 18 districts, to provide primary
healthcare services through
medical‑social collaboration and
public‑private partnerships, with
the focus on elderly residents. A
DHC is a service hub with a core
centre serving as headquarters,
complemented by satellite centres
in sub-districts at convenient
locations. The Government
envisages "the DHC to be a model
for district‑based medical‑social
collaboration, using big data to
identify the areas of medical care
services, establishing a framework
to implement measures on disease
prevention in a more systematic manner … and strengthening
scientifically proven service provision
and policy‑led development work."
(The Chief Executive's 2017 Policy
Address).
The first DHC was implemented
in Kwai Tsing District. In applying
our TRS-developed algorithms
to HK-wide Electronic Health
Records (EHRs) made accessible
by the Hospital Authority's Data
Collaboration Lab (HADCL),
we were able to characterise
district-specific profiles of highrisk
residents in the community
and their secondary and tertiary
prevention needs. These tools
can be further developed and
used to inform service planning
for DHCs. Although Hong Kong
public hospitals take up to 90% of
total inpatients, the private sector
possesses the lion's share of primary
care capacity. However, utilising this
extra capacity and advanced tech
in the private sector has remained
a challenge. These tools can be
further developed to assist decisionmakers
at DHCs as well as general
practitioners to unlock this capacity.
#4 Improved resource
management
Resource pooling and sharing
among hospitals are important
topics in healthcare management
research. The team advised on the
Hospital Authority's ten-year plan
for the non-emergency ambulance
service by providing a consultative
report reviewing its patient
transport service.
#5 Data analytics tools
for future healthcare
research
Healthcare information and data
analytics underlie the achievements
and social impact of all other
project tasks. The tool kits that have
been developed will be of generic
use in advancing future healthcare
research.
The team developed a number of
machine learning models to predict
the onset of various diseases that
are critical in Hong Kong, including
heart failure, mitral regurgitation,
acute myocardial infarction,
dementia, suicide and depression
risk assessment, etc. They also
developed advanced machine
learning models for predicting
future high-cost patients, for
example, COPD, and infectious
disease models.
Sensor technology has been utilised
in the project for monitoring and
assessment of elderly's health,
including general wellness, blood
pressure, gait and balance. The
team found that sensors provided
researchers with important data, for
comprehensive evaluation of health
conditions and fall risk prediction.
A general framework of system
health monitoring and management
(SHMM) has been proposed. It
covers continuous surveillance,
analysis and interpretation of
related data for system monitoring,
management and strategic
planning. The team provided a new
perspective on health monitoring
and the management of complex systems, such as health systems in a
big data environment.
Legacy – a new phase of
collaborative healthcare
management
In November 2018, Our Hong Kong
Foundation published a report
on Hong Kong's health system,
entitled "Fit for Purpose: A Health
System for the 21st Century,"
which was led by Prof Eng-kiong
Yeoh from the Public Health Team,
Chinese University of Hong Kong.
It was officially released at the
"Our Hong Kong Foundation"
Health Systems Summit, which was
keynoted by the Chief Executive.
The Hong Kong Hospital Authority
also commissioned the CityU
team at the College of Business to
prepare the planning of services
and business models of patient
transport service (Non-Emergency
Ambulatory Transfer Service, NEATS,
and Elderly Transport Service, ETS),
for the ten-year period of 2018-
2027.
As Professor Chen put it: "We feel
the successful completion of this
TRS project is just the start of a new
phase of collaborative healthcare
management research in Hong
Kong."
"The achievements in the past
five years have provided us with
an opportunity for long-term
interdisciplinary collaboration and
sustainable development in elderly
care in Hong Kong."
HomAge: Home-based aging for
transformative community care
The College of Business is actively
pursuing their research work in
healthcare. A team comprising
CB faculty members alongside
Jockey Club School of Public Health
and Primary Care of the Chinese
University of Hong Kong, has
recently been awarded $23.8M
funding from Bank of China
(Hong Kong) Centenary Charity
Programme (Secretariat: The Hong
Kong Council of Social Service).
"HomAge: Home-based aging for
transformative community care,"
is a pilot project to implement the
home-based care programme based
on the Buurtzorg homecare model
which has seen global uptake. This
3-year project will leverage on an IT
platform for service planning and
coordination, and deploy the AI/
data analytics tools developed in the
Delivering 21st Century Healthcare
TRS project to identify the elderly
segment(s) for the most effective
and affordable community-based
cares, including post-discharge care
portfolios. The proposed homebased
care programme will provide
care services that complement the
DHC model.
Several Public Policy Research grants
have been obtained by the Team,
which will generate more policy
reports for the government.
The College of Business looks
forward to working with our
partners across the educational
and healthcare sectors in delivering
further collaborative projects which
will positively impact on quality
delivery in Hong Kong's healthcare
systems.
