1,682 research outputs found

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

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    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

    IMPROVING HEALTHCARE DELIVERY: LIVER HEALTH UPDATING AND SURGICAL PATIENT ROUTING

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    Growing healthcare expenditures in the United States require improved healthcare delivery practices. Organ allocation has been one of the most controversial subjects in healthcare due to the scarcity of donated human organs and various ethical concerns. The design of efficient surgical suites management systems and rural healthcare delivery are long-standing efforts to improve the quality of care. In this dissertation, we consider practical models in both domains with the goal of improving the quality of their services. In the United States, the liver allocation system prioritizes among patients on the waiting list based on the patients' geographical locations and their medical urgency. The prioritization policy within a given geographic area is based on the most recently reported health status of the patients, although blood type compatibility and waiting time on the list are used to break ties. Accordingly, the system imposes a health-status updating scheme, which requires patients to update their health status within a timeframe that depends on their last reported health. However, the patients' ability to update their health status at any time point within this timeframe induces information asymmetry in the system. We study the problem of mitigating this information asymmetry in the liver allocation system. Specifically, we consider a joint patient and societal perspective to determine a set of Pareto-optimal updating schemes that minimize information asymmetry and data-processing burden. This approach combines three methodologies: multi-objective optimization, stochastic programming and Markov decision processes (MDPs). Using the structural properties of our proposed modeling approach, an efficient decomposition algorithm is presented to identify the exact efficient frontier of the Pareto-optimal updating schemes within any given degree of accuracy. Many medical centers offer transportation to eligible patients. However, patients' transportation considerations are often ignored in the scheduling of medical appointments. In this dissertation, we propose an integrated approach that simultaneously considers routing and scheduling decisions of a set of elective outpatient surgery requests in the available operating rooms (ORs) of a hospital. The objective is to minimize the total service cost that incorporates transportation and hospital waiting times for all patients. Focusing on the need of specialty or low-volume hospitals, we propose a computationally tractable model formulated as a set partitioning based problem. We present a branch-and-price algorithm to solve this problem, and discuss several algorithmic strategies to enhance the efficiency of the solution method. An extensive computational test using clinical data demonstrates the efficiency of our proposed solution method. This also shows the value of integrating routing and scheduling decisions, indicating that the healthcare providers can substantially improve the quality of their services under this unified framework

    Operational Research: Methods and Applications

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    Throughout its history, Operational Research has evolved to include a variety of methods, models and algorithms that have been applied to a diverse and wide range of contexts. This encyclopedic article consists of two main sections: methods and applications. The first aims to summarise the up-to-date knowledge and provide an overview of the state-of-the-art methods and key developments in the various subdomains of the field. The second offers a wide-ranging list of areas where Operational Research has been applied. The article is meant to be read in a nonlinear fashion. It should be used as a point of reference or first-port-of-call for a diverse pool of readers: academics, researchers, students, and practitioners. The entries within the methods and applications sections are presented in alphabetical order. The authors dedicate this paper to the 2023 Turkey/Syria earthquake victims. We sincerely hope that advances in OR will play a role towards minimising the pain and suffering caused by this and future catastrophes

    An Optimization Framework for a Dynamic Multi-Skill Workforce Scheduling and Routing Problem with Time Windows and Synchronization Constraints

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    This article addresses the dynamic multi-skill workforce scheduling and routing problem with time windows and synchronization constraints (DWSRP-TW-SC) inherent in the on-demand home services sector. In this problem, new service requests (tasks) emerge in real-time, necessitating a constant reevaluation of service team task plans. This reevaluation involves maintaining a portion of the plan unaltered, ensuring team-task compatibility, addressing task priorities, and managing synchronization when task demands exceed a team's capabilities. To address the problem, we introduce a real-time optimization framework triggered upon the arrival of new tasks or the elapse of a set time. This framework redesigns the routes of teams with the goal of minimizing the cumulative weighted throughput time for all tasks. For the route redesign phase of this framework, we develop both a mathematical model and an Adaptive Large Neighborhood Search (ALNS) algorithm. We conduct a comprehensive computational study to assess the performance of our proposed ALNS-based reoptimization framework and to examine the impact of reoptimization strategies, frozen period lengths, and varying degrees of dynamism. Our contributions provide practical insights and solutions for effective dynamic workforce management in on-demand home services

    Operational Research: Methods and Applications

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    Throughout its history, Operational Research has evolved to include a variety of methods, models and algorithms that have been applied to a diverse and wide range of contexts. This encyclopedic article consists of two main sections: methods and applications. The first aims to summarise the up-to-date knowledge and provide an overview of the state-of-the-art methods and key developments in the various subdomains of the field. The second offers a wide-ranging list of areas where Operational Research has been applied. The article is meant to be read in a nonlinear fashion. It should be used as a point of reference or first-port-of-call for a diverse pool of readers: academics, researchers, students, and practitioners. The entries within the methods and applications sections are presented in alphabetical order

    Scheduling Sustainable Homecare with Urban Transport and Different Skilled Nurses Using an Approximate Algorithm

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    The essential characteristics that distinguish homecare services from other routing and scheduling problems are relatively few patients being spread out over a large urban area, long transport times and several different services being provided. The approach that the authors present herein was developed to solve planning homecare services according to the criterion of increasing social sustainability and incorporating environmentally sustainable transport systems. The objective of this paper is to present a tool to plan the daily work carried out by a homecare service with assigned patients with specific care requirements. It relies on the resources of nurses with different qualifications by assuming costs that depend on both offering the service and the different chosen transport modes. The algorithm manages several priority rules by ensuring that homecare provider goals and standards are met. The developed algorithm was tested according to the weekly homecare schedule of a group of nurses in a medium-sized European city and was successfully used during validation to improve homecare planning decisions. The results, therefore, are not generalisable but its modular structure ensures its applicability to different cases. The algorithm provides a patient-centred visiting plan and improves transport allocation by offering nurses a better route assignment by considering the required variables and each nurse's daily workload.This research was founded Young Researcher Training granted by the Mediterranean Institute for Advanced Studies (MEDIFAS) according to the contract reached between the Slovenian Research Agency (ARRS) and MEDIFAS

    "You have to get wet to learn how to swim" applied to bridging the gap between research into personnel scheduling and its implementation in practice

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    Personnel scheduling problems have attracted research interests for several decades. They have been considerably changed over time, accommodating a variety of constraints related to legal and organisation requirements, part-time staff, flexible hours of staff, staff preferences, etc. This led to a myriad of approaches developed for solving personnel scheduling problems including optimisation, meta-heuristics, artificial intelligence, decision-support, and also hybrids of these approaches. However, this still does not imply that this research has a large impact on practice and that state-of-the art models and algorithms are widely in use in organisations. One can find a reasonably large number of software packages that aim to assist in personnel scheduling. A classification of this software based on its purpose will be proposed, accompanied with a discussion about the level of support that this software offers to schedulers. A general conclusion is that the available software, with some exceptions, does not benefit from the wealth of developed models and methods. The remaining of the paper will provide insights into some characteristics of real-world scheduling problems that, in the author’s opinion, have not been given a due attention in the personnel scheduling research community yet and which could contribute to the enhancement of the implementation of research results in practice. Concluding remarks are that in order to bridge the gap that still exists between research into personnel scheduling and practice, we need to engage more with schedulers in practice and also with software developers; one may say we need to get wet if we want to learn how to swim

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

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    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
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