COUNTERFACTUAL MODEL OF A MEDICAL BUSINESS PROCESS
DOI:
https://doi.org/10.20998/2079-0023.2026.01.06Keywords:
medical business process, counterfactual model, situational model, structural causal model, temporal rules, clinical constraints, temporal constraints, individualized treatmentAbstract
The subject of the research is medical business processes. The aim of the work is to develop a counterfactual model of a medical business process in order to enable the selection of alternative decisions when providing primary medical care, subsequent outpatient treatment, as well as clinical pathways and rehabilitation. Achieving this aim is oriented towards ensuring the flexibility of medical business processes under resource, financial, and regulatory constraints. To achieve the aim, the following tasks are addressed: to develop the formal structure of a counterfactual model of a medical business process as an extension of a situational model of a generalized medical business process, including causal dependencies and a system of temporal rules that describe admissible event sequences and time intervals between them; to perform an experimental validation of a system of clinical constraints that defines the space of possible counterfactual scenarios. A counterfactual model of a medical business process is proposed which, in contrast to existing approaches, combines the situational structure of a medical business process, a causal graph of reasons for performing process actions, a system of constraints that determine the feasibility of process trajectories in accordance with clinical guidelines, as well as temporal rules that define the sequence of medical business process events in time. Experimental validation of the model, taking into account the system of constraints, the causal graph, and the temporal rules, has confirmed a reduction in the share of clinically unacceptable scenarios compared to the traditional approach to constructing counterfactual explanations. Further development of the proposed counterfactual model of a medical business process is associated with the design of an information technology for decision support in medical business processes, aimed at constructing individualized treatment pathways that take into account patient needs and the constraints of the healthcare system.
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