Abstract
Ensuring timely access to specialty healthcare in rural areas is challenging due to long appointment delays, travel distances, budget limitations, and capacity restrictions. Since capacity and resource allocation decisions are often made infrequently, unanticipated population changes, for example, can render current good solutions ineffective for future challenges. To meet long-term care needs under uncertainty, single-period and multi-period optimization models are developed to optimize practice locations, clinician staffing, and assignment of patients which accounts for uncertainty and variation in acuity, demand volume, and long-term provider capacity. The objective is to improve access and care continuity by minimizing patient travel and appointment delays, out-of-network referrals, and practice costs. Deterministic, robust, and chance-constrained optimization models are developed, and their results are compared and applied to a large health system for cardiovascular services in Maine, United States. Through scenario analysis, we show which resources are the most critical and what helps increase patients’ access. More generally, considering multiple-periods and uncertainty at the same time when allocating resources help health systems make important capacity planning decisions in the presence of uncertain future demand. For both single- and multiple-periods, the robust model requires more staff in general to keep a comparable number of zip codes covered with a minimal increase in operating costs. The solution under the chance-constrained model is very similar to the deterministic one; this shows that the deterministic solution is feasible in 95% of most the cases.
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26 April 2022
A Correction to this paper has been published: https://doi.org/10.1007/s10696-022-09451-0
References
Afshari H, Peng Q (2014) Challenges and solutions for location of healthcare facilities. Ind Eng Manag 3(2):1–12
Ahmadi A, Najafi M (2017) Blood inventory management in hospitals: considering supply and demand uncertainty and blood transshipment possibility. Oper Res Health Care 15:43–56
Ahmadi-Javid A, Ramshe N (2020) A stochastic location model for designing primary healthcare networks integrated with workforce cross-training. Oper Res Health Care 24:100226
Ahmadi-Javid A, Seyedi P, Syam S (2017) A survey of healthcare facility location. Comput Oper Res 79:223–263
Baron O, Milner J, Naseraldin H (2011) Facility location: a robust optimization approach. Prod Oper Manag 20(5):772–785
Benneyan JC, Musdal H, Ceyhan ME, Shiner B, Watts BV (2012) Specialty care single and multi-period location-allocation models within the Veterans Health Administration. Socio-Econ Plann Sci 46(2):136–148
Bertsimas D, Sim M (2004) The price of robustness. Oper Res 52(1):35–53
Cardoso T, Oliveira M, Barbosa-Póvoa A, Nickel S (2015) An integrated approach for planning a long-term care network with uncertainty, strategic policy and equity considerations. Eur J Oper Res 247:321–334
Correia I, Saldanha-da Gama F (2020) Facility location under uncertainty. In: Nickel S, Saldanha-da Gama F (eds) Location science. Springer, Cham, pp 185–213
Davis K, Schoenbaum SC, Audet AM (2005) A 2020 vision of patient-centered primary care. J Gen Intern Med 20(10):953–957
Ghaderi A, Jabalameli M (2013) Modeling the budget-constrained dynamic uncapacitated facility location-network design problem and solving it via two efficient heuristics: a case study of healthcare. Math Comput Modell 57(3):382–400
Gruca TS, Pyo T, Nelson GC (2016) Providing cardiology care in rural areas through visiting consultant clinics. J Am Heart Assoc 5(7):1–10
Harper P, Shahani A, Gallagher J, Bowie C (2005) Planning health services with explicit geographical considerations: a stochastic location-allocation approach. Omega 33(2):141–152
Jakubovskis A (2017) Strategic facility location, capacity acquisition, and technology choice decisions under demand uncertainty: robust vs. non-robust optimization approaches. Eur J Oper Res 260:1095–1104
Jones W, Elwyn G, Edwards P (2003) Measuring access to primary care appointments: a review of methods. BMC Family 4(1):8
Karamyar F, Sadeghi J, Yazdi MM (2016) A Benders decomposition for the location-allocation and scheduling model in a healthcare system regarding robust optimization. Neural Comput Appl 29:873–886
Kinay O, Yetis Kara B, Saldanha-da Gama F, Correia I (2018) Modeling the shelter site location problem using chance constraints: a case study for Istanbul. Eur J Oper Res 270(1):132–145
Liu K, Li Q, Zhang Z (2019) Distributionally robust optimization of an emergency medical service station location and sizing problem with joint chance constraints. Transport Res Part B: Method 119:79–101
Meng F, Qi J, Zhang M, Ang J, Chu S, Sim M (2015) A robust optimization model for managing elective admission in a public hospital. Oper Res 63(6):1452–1467
Mestre A, Oliveira M, Barbosa-Póvoa A (2015) Location-allocation approaches for hospital network planning under uncertainty. Eur J Oper Res 240(3):791–806
Mitropoulos P, Mitropoulos I, Giannikos I (2013) Combining DEA with location analysis for the effective consolidation of services in the health sector. Comput Oper Res 40(9):2241–2250
Motallebi Nasrabadi A, Najafi M, Zolfagharinia H (2020) Considering short-term and long-term uncertainties in location and capacity planning of public healthcare facilities. Eur J Oper Res 281:152–173
Ndiaye M, Alfares H (2008) Modeling healthcare facility location for moving population groups. Comput Oper Res 35(7):2154–2161
Neyshabouri S, Berg B (2017) Two-stage robust optimization approach to elective surgery and downstream capacity planning. Eur J Oper Res 260(1):21–40
Nikouei Mehr M, McGarvey RG (2017) Planning solid waste collection with robust optimization: location-allocation, receptacle type, and service frequency. Adv Oper Res 2017:1–14
Rahmaniani R, Rahmaniani G, Jabbarzadeh A (2014) Variable neighborhood search based evolutionary algorithm and several approximations for balanced location-allocation design problem. Int J Adv Manufac Technol 72(1–4):145–159
Saif A, Elhedhli S (2018) Sterilization network design. EURO J Transport Logist 8:91–115
Shishebori D, Babadi A (2015) Robust and reliable medical services network design under uncertain environment and system disruptions. Transp Res Part E: Logist Transp Rev 77:268–288
State of Maine - Office of Policy and Management (2017) Maine economics and demographics program—projections. http://maine.gov/economist/projections/index.shtml
Stummer C, Doerner K, Focke A, Heidenberger K (2004) Determining location and size of medical departments in a hospital network: a multiobjective decision support approach. Health Care Manag Sci 1(1):63–71
US Census Bureau (2015) 2010 Census urban and rural classification and urban area criteria. https://www.census.gov/geo/reference/ua/urban-rural-2010.html
VA Office of Inspector General (2014) Veterans health administration review of alleged patient deaths, patient wait times, and scheduling practices at the phoenix VA health care system. https://www.va.gov/oig/pubs/VAOIG-14-02603-267.pdf
Virani SS, Maddox TM, Chan PS, Tang F, Akeroyd JM, Risch SA, Oetgen WJ, Deswal A, Bozkurt B, Ballantyne CM, Petersen LA (2015) Provider type and quality of outpatient cardiovascular disease care: insights from the NCDR PINNACLE registry. J Am Coll Cardiol 66(16):1803–1812
Wong S, Regan S (2009) Patient perspectives on primary health care in rural communities: effects of geography on access, continuity and efficiency. Rural Remote Health 9:1142
Zahiri B, Tavakkoli-Moghaddam R, Pishvaee MS (2014) A robust possibilistic programming approach to multi-period location-allocation of organ transplant centers under uncertainty. Comput Ind Eng 74:139–148
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In this article Khedidja Seridi at affiliation ‘CIRRELT’ was missing from the author list. The order of author should be Dominic J. Breuer · Khedidja Seridi · Nadia Lahrichi · Mohit Shukla · James C. Benneya. The original article has been corected.
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Breuer, D.J., Seridi, K., Lahrichi, N. et al. Robust multi-period capacity, location, and access of rural cardiovascular services under uncertainty. Flex Serv Manuf J 34, 1013–1039 (2022). https://doi.org/10.1007/s10696-021-09436-5
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DOI: https://doi.org/10.1007/s10696-021-09436-5