I. Uluslararası Sağlıkta Performans ve Kalite Kongresi Bildiriler ...

Performansa Dayalı Ek Ödeme Sistemi, Yapay Sinir Ağı, Bulanık Mantık, Uyarlanabilir
Bulanık Çıkarım Sistemi, ANFIS
Abstract
Performance based supplementary payment system in health (PBSPSIH) is a
payment system which aims to award employees based on the rate of success in
order to increase efficiency and quality in health services. Sometimes, abuses may
occur in PBSPSIH. These abuses affect negatively self-sacrificing and hard working
staff. Employees who do not deserve what they are paid cause an increase in health
expenditures and decline in employee motivation and satisfaction. With this study,
it is aimed to investigate whether the problem of abuse detection in PBSPSIH can
be solved automatically or not and to develop intelligent algorithms in order to
solve the problem.
With large scale of data, abuse detection with standard methods could be very
diffucult and take long times. Data mining techniques providing efficient detection
ability in huge data are used in this study. Firstly, the techniques such as rule based
predictive modeling, fuzzy logic, artificial neural networks, decision trees and their
applications are examined in order to select proper data mining techniques. After
these examination, an hybrid system consisting of more than one techniques is
designed. This system is composed of three steps such as data preprocessing,
constructing detection model and evaluation. In the step of data preprocessing,
performance knowledgebase is prepared from the raw data in databases of hospital
information systems by processing systematically. In the second step, a rule based
intelligent detection model is also prepared with the help of knowledgebase prepared.
At last step, probable abuse records are presented to experts for investigation by
means of processing the data according to the detection model. The model is
updated continuously according to the feedbacks of experts. Also, system designing
is executed in a way that enables to compare model results with those gathered
though interviews with expert managers.
With this new model proposed in this study, abuse detection is not restricted to case
based queryings which is done by only experts with limited success. Additionally,
unusual abuse events can be detected by machine, and detection speed can be
increased.
Key Words: Data Mining, Medical Informatics, Database, Abuse Detection,
Performance Based Supplementary Payment System, Artificial Neural Networks,
Fuzzy Logic, Adaptive Neuro-Fuzzy Inference System, ANFIS
1. GİRİŞ
Sağlık hizmetlerinde kaliteyi arttırmak ve çalışanların başarıları oranında
ödüllendirilmelerini sağlamak amacıyla, Sağlık Bakanlığı tarafından performansa
dayalı ek ödeme sistemi uygulamaya konulmuştur (Aydın ve Demir, 2007: 1).
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