Gestión logística de sistemas de hospitalización domiciliaria: una revisión crítica de modelos y métodos

RESUMEN: Los servicios de Hospitalización Domiciliaria (HD) se basan en una red de distribución, en la cual los pacientes son hospitalizados en sus casas y los prestadores de servicios de salud deben entregar cuidados médicos coordinados a los pacientes. La demanda de estos servicios está creciendo rápidamente y los gobiernos y proveedores de servicios de salud enfrentan el reto de tomar un conjunto de decisiones complejas en un sector con un componente logístico importante. En este artículo se presenta una revisión crítica de los modelos y métodos utilizados para darle soporte a las decisiones logísticas en HD. Para esto se presenta primero un marco de referencia, con el objetivo de identificar las oportunidades de investigación en el campo. Con base en dicho marco, se presenta la revisión de la literatura y la identificación de brechas en la investigación. En particular, se hace énfasis en la necesidad de desarrollar e implementar metodologías más integradas para dar soporte a las decisiones estratégicas y tácticas y de considerar puntos clave de los sistemas reales.ABSTRACT: Home Health Care (HHC) services are based on a delivery network in which patients are hospitalized at their homes and health care providers must deliver coordinated medical care to patients. Demand for HHC services is rapidly growing and governments and health care providers face the challenge to make a set of complex decisions in a medical service business that has an important component of logistics problems. The objective of this paper is to provide a critical review of models and methods used to support logistics decisions in HHC. For this purpose, a reference framework is proposed first in order to identify research perspectives in the field. Based on this framework, a literature review is presented and research gaps are identified. In particular, the literature review reveals that more emphasizes is needed to develop and implement more integrated methodologies to support decisions at tactical and strategic planning levels and to consider key features from real systems

Planning Strategies for Home Health Care Delivery

In home health care, continuity of care, wherein a patient is always visited by the same nurse, can be just as important as cost, as it is closely correlated to quality of care. While a patient typically receives care for two to three months, such that assigning a nurse to a patient impacts operations for lengthy periods of time, previous research focusing on continuity of care uses planning horizons that are often a week or shorter. This paper computationally demonstrates that considering a long planning horizon in this setting has significant potential for savings. Initially, a deterministic setting is considered, with all patient requests during the planning horizon known a priori, and the routing cost of planning for two to three months is compared with the cost when planning is done on a weekly basis. With inherent uncertainty in planning for such a long time horizon, a methodology is presented that anticipates future patient requests that are unknown at the time of planning. Computational evidence shows that its use is superior to planning on a weekly basis under uncertainty

A two-phase approach for periodic home health care planning

International audienceIn this paper, we study the problem of periodic vehicle routing encountered in Home Health Care (HHC). The problem can be considered as a Periodic Vehicle Routing Problem with Time Windows (PVRPTW). It consists in establishing a planning of visits to patients over a given time horizon so as to satisfy the adherence to the care plan while optimizing the routes used in each time period. One two-stage mathematical formulation of this problem is proposed. We then propose a Tabu Search (TS) and a MIP-based Neighborhood Search method to compute the weekly and daily plan, respectively. These approaches are tested on large size instances

Workload Equity in Vehicle Routing Problems: A Survey and Analysis

Over the past two decades, equity aspects have been considered in a growing number of models and methods for vehicle routing problems (VRPs). Equity concerns most often relate to fairly allocating workloads and to balancing the utilization of resources, and many practical applications have been reported in the literature. However, there has been only limited discussion about how workload equity should be modeled in VRPs, and various measures for optimizing such objectives have been proposed and implemented without a critical evaluation of their respective merits and consequences. This article addresses this gap with an analysis of classical and alternative equity functions for biobjective VRP models. In our survey, we review and categorize the existing literature on equitable VRPs. In the analysis, we identify a set of axiomatic properties that an ideal equity measure should satisfy, collect six common measures, and point out important connections between their properties and those of the resulting Pareto-optimal solutions. To gauge the extent of these implications, we also conduct a numerical study on small biobjective VRP instances solvable to optimality. Our study reveals two undesirable consequences when optimizing equity with nonmonotonic functions: Pareto-optimal solutions can consist of non-TSP-optimal tours, and even if all tours are TSP optimal, Pareto-optimal solutions can be workload inconsistent, i.e. composed of tours whose workloads are all equal to or longer than those of other Pareto-optimal solutions. We show that the extent of these phenomena should not be underestimated. The results of our biobjective analysis are valid also for weighted sum, constraint-based, or single-objective models. Based on this analysis, we conclude that monotonic equity functions are more appropriate for certain types of VRP models, and suggest promising avenues for further research.Comment: Accepted Manuscrip

A Method for Designing Efficient Routes for Home Healthcare Agencies Considering Uncertain Future Demand

Faced with increasing demand for home health care that is rising faster than the supply of resources needed to deliver it and drastic budget cuts, many home care agencies are struggling to remain operational. There is a need for efficient routing that doesn’t compromise on the quality of care achieved when a patient is visited by the same nurse over the entire period of care, also known as care-giver continuity or continuity of care. Because care periods often last more than 60 days, care-giver continuity causes scheduling decisions to have a long-term impact by potentially restricting the agency from making alternative assignments that could reduce routing costs. Our research aims to understand and quantify the benefit of utilizing time horizons of 60- 90 days when making routing decisions under the constraint of continuity of care. We do so by defining the Home Health Care Routing Problem (HHCRP) as a variant of the Vehicle Routing Problem (VRP), known as the Consistent VRP, that includes the continuity of care requirement. Unlike related literature on this problem which considers planning horizons of at most a week, computational experiments in a variety of settings suggest the importance of considering planning horizons of 2-3 months when developing schedules for care-givers. Given that it is almost impossible to have complete information about future patients that far ahead, we also present a method that enables planners to design schedules for care-givers in the face of such uncertainty and demonstrate its effectiveness computationally

Planning the delivery of home-based long-term care: A mathematical programming-based tool to support routes' planning

The adequate planning of home-based long-term care (HBLTC) is essential in the current European setting where long-term care (LTC) demand is increasing rapidly, and where home-based care represents a potential cost-saving alternative from traditional inpatient care. Particularly, this planning should involve proper route planning to ensure visits of health professionals to patients’ homes. Nevertheless, literature in the specific area of HBLTC planning is still scarce. Accordingly, this paper proposes a tool based on a mathematical programming model – the LTCroutes – for supporting the daily planning of routes to visit LTC patients’ homes in National Health Service-based countries. The model allows exploring the impact of considering different objectives relevant in this sector, including the minimization of costs and the maximization of service level. Patients’ preferences, traffic conditions and budget constraints are also considered in the proposed model. To illustrate the applicability of the model, a case study based on the National Network of LTC in Portugal (RNCCI) is analysed.O planeamento adequado de cuidados continuados ao domicílio é essencial na conjuntura atual Europeia em que a procura de cuidados continuados está a aumentar rapidamente, e em que os cuidados ao domicílio representam uma alternativa com potencial de poupança de custos relativamente ao tradicional internamento hospitalar. Particularmente, é necessário haver um planeamento adequado das rotas dos profissionais de saúde às casas dos pacientes. No entanto, a literatura na área específica de planeamento de cuidados continuados ao domicílio ainda é escassa. Nesse sentido, este artigo propõe uma ferramenta baseada num modelo de programação matemática - o LTCroutes - para apoiar o planeamento diário das rotas para visitar as casas dos pacientes com necessidade de cuidados continuados em países com Serviço Nacional de Saúde. O modelo desenvolvido permite explorar o impacto de considerar diferentes objetivos relevantes neste setor, incluindo a minimização de custos e a maximização do nível de serviço. As preferências dos pacientes, condições de trânsito e restrições de orçamento também são consideradas no modelo proposto. Para ilustrar a aplicabilidade do modelo, é analisado um caso de estudo baseado na Rede Nacional de Cuidados Continuados Integrados (RNCCI) em Portugal

Periodic vehicle routing problem in a health unit

In logistics of home health care services in the Health Units, the managers and nurses need to carry out the schedule and the vehicles routes for the provision of care at the patients' homes. Currently, in Portugal, these services are increasingly used but the problem is still, usually, solved manually and without computational resources. The increased demand for home health care due to the boost of the elderly people number entails a high associated cost which, sometimes, does not guarantee the quality of the service. In this sense, the periodic vehicle routing problem is a generalization of the classical vehicle routing problem in which routes are determined for a time horizon of several days. In this work, it is provided a periodic vehicle routing problem applied in the Health Unit in Bragança. An integer linear programming formulation for the real database, allowed to solve the problem in an efficient and optimized way using the CPLEXR software.Programa Operacional Temático Factores de Competitividade(POCI-01-0145-FEDER-007043

A hybrid approach to operational planning in home health care

Home health care (HHC) management needs to plan their operations to synchronize professionals and allocate resources to perform several HHC services needed by patients. The growing demand for this type of service dictates the interest of all the stakeholders (professionalsand patients) in finding high-quality daily solutions and logistics. Routing and scheduling are problems of combinatorial nature, extremely complex, and require sophisticated optimization approaches. This work aims to contribute to cost-efficient decision-making in the general improvement of the service quality. Thus, a mixed integer linear programming model, a genetic algorithm, and a hybrid approach were used to solve the operational planning through test instances of different sizes for public home care providers. Computational results are presented, followed by a discussion on the advantages and shortcomings, highlighting the strength of each approach.The authors are grateful to the Foundation for Science and Technology (FCT, Portugal) for financial support through national funds FCT/MCTES (PIDDAC) to CeDRI (UIDB/05757/2020 and UIDP/05757/2020), SusTEC (LA/P/0007/2021) and ALGORITMI Center (UIDB/00319/2020). Filipe Alves thanks the Foundation for Science and Technology (FCT, Portugal) for supporting its research with the PhD grant SFRH/BD/143745/2019.info:eu-repo/semantics/publishedVersio

Modelling and (re-)planning periodic home social care services with loyalty and non-loyalty features

This work was partially supported by the Fundacao para a Ciencia e a Tecnologia (Portuguese Foundation for Science and Technology) through the project UID/MAT/00297/2019 (Centro de Matematica e Aplicacees).The aging population alongside little availability of informal care are two of the several factors leading to an increased need for assisted living support. In this work, we tackle a home social care service problem, motivated by two real case studies where a new loyalty scheme must be considered: within a week, patient-caregiver loyalty should be pursued but, between weeks, the caregivers must rotate among patients (non-loyalty). In addition, a common situation in this kind of service is also addressed: the need of a constant re-planning caused by the leaving of patients and the arrival of new ones. This new plan should be such that minimum disturbance is caused to the visiting hours of current patients, the caregivers’ travelling time between visits is minimized, and the workload is balanced among caregivers. A multi-objective optimization approach based on mixed-integer models is developed. Results on the two real case studies show that both institutions can efficiently re-plan their activities without much disturbance on the visits of their patients, and with a patient-caregiver loyalty scheme suiting their needs.authorsversionpublishe