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By:Serpil Mutlu
Published on 2015 by

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Since the early 1960s scheduling problems in health care have been a focus for industrial engineers and operations researchers, utilizing a wide range of solution techniques and types of problems. A general area of increasing importance in health care concerns co-scheduling or coordinating the scheduling of teams of care providers, such as for complex procedures, team-based primary care, or integrating specialty and primary care. These new models of care present unique and challenging scheduling needs that lend themselves well to mathematical programming solution approaches. This dissertation applies optimization to three specific care coordination problems focused on team collaboration and care continuity in primary, specialty, and inpatient settings: (1) multidisciplinary team scheduling for co-availability, (2) resident scheduling for continuity of primary care, and (3) integrated scheduling of specialty and primary care using telehealth. The first area of focus is a co-availability scheduling problem that arises in various healthcare settings in which personnel from different disciplines are required to work together as care teams to perform specific tasks. This problem is characterized by the asynchrony in availability of these personnel, which we optimize to facilitate teamwork and improve timeliness of care by reducing unnecessary delays. Integer and constraint programming techniques are developed to maximize scheduling-rescheduling flexibility, while satisfying coverage, time, resource, and preference constraints. Applications to breast cancer treatment in two different health systems illustrate the potential improvement on team quality and procedure timeliness. The second problem focuses on optimizing individual scheduling templates of multiple primary care teams in order to increase patient-team continuity and access, typically including the complexity of resident scheduling. This new care model focuses on a small care team instead of a single provider as a consistent source of care for primary care patients. An integer programming model is developed to maximize team coverage by assigning clinicians to their tasks in accordance with various educational and clinical requirements in a way that improves continuity of care. Application of the developed model to a family medicine residency clinic has significantly improved continuity and access leading to its integration into daily practice. Finally, the third area of focus is the integrated scheduling of primary care with remote specialist availability by utilizing telehealth resources. Under this approach, patients referred to a specialty service receive a consult with a specialist immediately after their primary care visit via medical videoconferencing technology. To optimize specialist scheduling, an integer programming model is developed to maximize the proportion of immediate videoconference consultations that can be satisfied by available resources. Off-line application to the Veteran Health Administration data suggests significant improvements are possible in timeliness and reduction in system-wide resource waste. Together, these three models address the scheduling challenges that healthcare practice in various levels has been facing in terms of care coordination. A deterministic perspective is utilized to optimize personnel schedules for enabling improvements in daily processes. Results of the models show that teamwork and care continuity can be supported by mathematical programming for enhanced care quality and efficient day-to-day operations.

This Book was ranked at 19 by Google Books for keyword healthcare administration problems.

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