Major Papers


multi-state, cox's model, Markov chain, time-homogeneous, intensity matrix, intervention


The top 1% of frequent users account for 34% of public health system expenditures in Ontario, while the top 5% account for 66%. In this paper, we explore the efficacy of an intervention aimed at reducing hospital utilization for a group of patients defined as frequent users, by using Multi-state modeling. We employ time-homogeneous, time-inhomogeneous, parametric and semi-parametric Markov processes to study the transitions of the patients between hospital, ER and outside during a follow up period of one year. The results do not indicate any strong evidence that the intervention was beneficial.

Primary Advisor

Yu Liang


A. Hussein and A. Snowdon

Program Reader

M. Hlynka

Degree Name

Master of Science


Mathematics and Statistics

Document Type

Major Research Paper