Home health care logistics planning: a review and framework

Home Health Care (HHC) is a growing industry in the medical services business, mainly in Europe and North America. These care services are provided at patients’ home by a multidisciplinary team using a distribution network. In this paper, an overview of the HHC services in Portugal and Brazil is presented. Additionally, a review is also presented to identify the main logistics problems associated with HHC services such as districting, routing and inventory management and the lack of integrated approaches to address them, as well as the best practices of management in the area. A framework is proposed to represent the main elements and characteristics of HHC services and their relationships. The framework suggests the use of a Decision Support System (DSS) based on optimization models and simulation approaches to overcome some of the main challenges associated to integrated approaches to address main problems, filling the gaps in the current literature. With the development of this DSS it will be possible to assist in the logistic planning of HHC teams, especially in countries like Brazil and Portugal.This work has been supported by CNPq (National Counsel of Technological and Scientific Development, Brazil) and COMPETE: POCI-01-0145-FEDER-007043 and FCT – Fundação para a Ciência e Tecnologia within the Project Scope: UID/CEC/00319/2013.info:eu-repo/semantics/publishedVersio

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

Spatial organization of public services: models and applications

Location decisions are crucial in the spatial organization in both public and private sectors as they can have a long term impact on operational performances and on service levels. Social cost minimization, universality of services and equity, expressed in terms of users' accessibility, are the main objectives in public services contexts. Nevertheless, the enduring trend of public expenditures revision poses, also in the public sectors, the need to pursue objectives of economic efficiency. In the literature, two families of optimization problems are typically used to address these problems, namely Facility Location Problems (FLPs) and Districting Problems (DPs). The aim of this thesis is to show how FLPs and DPs can be used to underpin spatial organization processes of public services, providing analytical models able to assist the decision making. To this end, novel mathematical models are developed with application to the healthcare and postal service sectors. In particular, a hierarchical facility location model is formulated to reorganize an existing regional Blood Management System (BMS) while an integrated location-districting model is proposed for the organization of postal collection operations in urban areas. A constructive heuristic procedure is also devised to solve the latter problem. Extensive computational experiments are realized to validate the proposed models and to show their capability to provide insightful managerial implications. Finally, the thesis aims at filling another existing gap in the literature due to the absence of stochastic models for DPs. Hence, a two-stage stochastic program for districting is introduced and tested on real georgaphic data. Several extensions of the proposed modeling framework are also discussed

Modelling home care organisations from an operations management perspective

Home Care (HC) service consists of providing care to patients in their homes. During the last decade, the HC service industry experienced significant growth in many European countries. This growth stems from several factors, such as governmental pressure to reduce healthcare costs, demographic changes related to population ageing, social changes, an increase in the number of patients that suffer from chronic illnesses, and the development of new home-based services and technologies. This study proposes a framework that will enable HC service providers to better understand HC operations and their management. The study identifies the main processes and decisions that relate to the field of HC operations management. Hence, an IDEF0 (Integrated Definition for Function Modelling) activity-based model describes the most relevant clinical, logistical and organisational processes associated with HC operations. A hierarchical framework for operations management decisions is also proposed. This analysis is derived from data that was collected by nine HC service providers, which are located in France and Italy, and focuses on the manner in which operations are run, as well as associated constraints, inputs and outputs. The most challenging research areas in the field of HC operations management are also discussed

Coordinated multi-criteria scheduling of caregivers in home health Care Services

International audienceHome health Care Services (HCS) that provides continuous and coordinated cares at patients' home. This paper addresses the problem of scheduling care activities, performed by caregivers belonging to a HCS. Care visits for the same patient might be done in some order (coordinated). The problem consists in determining a tour for all caregivers in order to optimize multiple criteria. We propose two mixed integer programming (MILP) models, each corresponding to a scheduling strategy. Numerical results are given to show the relationship between patient waiting times and caregiver working durations

Location models in the public sector

The past four decades have witnessed an explosive growth in the field of networkbased facility location modeling. This is not at all surprising since location policy is one of the most profitable areas of applied systems analysis in regional science and ample theoretical and applied challenges are offered. Location-allocation models seek the location of facilities and/or services (e.g., schools, hospitals, and warehouses) so as to optimize one or several objectives generally related to the efficiency of the system or to the allocation of resources. This paper concerns the location of facilities or services in discrete space or networks, that are related to the public sector, such as emergency services (ambulances, fire stations, and police units), school systems and postal facilities. The paper is structured as follows: first, we will focus on public facility location models that use some type of coverage criterion, with special emphasis in emergency services. The second section will examine models based on the P-Median problem and some of the issues faced by planners when implementing this formulation in real world locational decisions. Finally, the last section will examine new trends in public sector facility location modeling.Location analysis, public facilities, covering models

Strategic districting for the mitigation of educational segregation : a pilot model for school district optimization in Helsinki

Helsingin kaupunkirakenne on eriytynyt viimeisten vuosikymmenien aikana merkittävästi sosiaalisilla mittareilla tarkasteltuna. Kehitys on heijastunut kouluihin oppilaspohjien ja oppimistuloksien erojen kasvuna, minkä lisäksi Helsingissä on löydetty viitteitä myös itsenäisistä kouluvaikutuksista. Koulujen eriytymiskehityksen pelätään mainevaikutuksen kautta kiihdyttävän alueellista segregaatiota ja siten oppilaspohjien eriytymistä entisestään. Oppilaspohjien eroihin on kuitenkin mahdollista vaikuttaa määrittämällä oppilasalueet uudelleen tavalla, joka minimoi oppilasalueiden välisiä sosiaalisia eroja mahdollisimman tehokkaasti. Tätä varten tarvitaan uudenlaisia, koneoppimiseen perustuvia optimointityökaluja. Tämän opinnäytetyön päätavoitteena on tutkia mahdollisuutta optimoida Helsingin oppilasalueita väestöpohjiltaan sisäisesti heterogeenisemmiksi ja keskenään homogeenisemmiksi. Tavoitetta varten olen kehittänyt työssäni automatisoidun optimointimallin, joka minimoi sosiaalisten muuttujien varianssia oppilasalueiden välillä oppilasalueiden muotoa varioimalla. Mallin pilottisovelluksessa optimoin Helsingin oppilaaksiottoalueita tasaisemmiksi käyttäen optimoitavana muuttujana vieraskielisen väestön osuutta. Olemassa olevaa kouluverkostoa eli koulujen sijaintia, oppilasalueiden maantieteellistä yhtenäisyyttä, enimmäisoppilasmääriä koulukohtaisella marginaalilla sekä koulukohtaista koulumatkan enimmäispituutta on käytetty mallissa alueiden muodostamista rajoittavina tekijöinä. Tutkimukseni keskeinen löydös on, että oppilasaluerajoja siirtelemällä oppilasalueiden sosiaalisen pohjan eroihin voidaan vaikuttaa Helsingissä merkittävästi. Malli vaatii kuitenkin vielä perusteellista jatkokehittämistä soveltuakseen aluejakojen käytännön suunnitteluun, ja tässä vaiheessa sen merkittävimmät kehityskohteet liittyvät optimoitujen alueiden muotoon, mallin laskennalliseen vaativuuteen ja koulumatkojen turvallisuutta mittaavan optimointiparametrin puuttumiseen.The social urban structure of Helsinki has experienced a significant rise in spatial differences during the last two decades. This development has reflected on schools as rising differences between schools’ student compositions and learning outcomes. Additionally, signs of independent school effects have been observed in several studies. The differentiation of student compositions is feared to exacerbate residential segregation and differentiate schools’ operating environments further. It is possible, however, to intervene this development by drawing the school attendance districts such that the social differences between schools’ student compositions are effectively minimized. For this purpose, new machine learning based optimization tools are needed. The main objective of this master’s thesis study is to examine the possibility to optimize Helsinki’s school districts toward more internally heterogeneous and externally homogeneous social compositions. For this purpose, I have developed an optimization model that minimizes the variance of social variables between school districts by iteratively redrawing the districts’ borders. In a pilot application of the model I optimize the school districts of Helsinki by using the share of population with immigrant background as the optimization variable, while existing school infrastructure (the school locations and student capacities), spatial contiguity of the districts, and school-specific maximum travel distances are used as constraints restricting the shapes that the districts can take. The core finding of this study is that in Helsinki, the social compositions of school districts can be significantly evened out by redrawing the school district borders. However, for the model to be suitable for district planning in practice it needs further development. At this stage, the main limitations of the model are related to the shapes of the optimized districts, the model’s time complexity and the lack of a constraint or optimization parameter that accounts for the safety of children’s school trips