Sarang Deo is Assistant Professor of Operations Management at the Indian School of Business. His primary area of interest is health care operations with special emphasis on investigating the impact of operations decisions on population level health outcomes. He has studied the influenza vaccine supply chain and the phenomenon of ambulance diversion (in the US), the adult HIV treatment supply chains and the infant HIV diagnosis networks in sub-Saharan Africa, and more recently the TB diagnosis pathway in rural India. He frequently collaborates with international agencies such as the Clinton Health Access Initiative and the Bill and Melinda Gates Foundation and his research has been funded by the US National Science Foundation and Grand Challenges Canada.
Prior to joining the ISB, Sarang was Assistant Professor at the Kellogg School of Management. He was a management consultant in the Accenture’s Mumbai office before embarking on an academic career. Sarang has a PhD from UCLA Anderson School of Management, MBA from IIM Ahmedabad, and BTech from IIT Bombay.
This paper studies a model of community-based healthcare delivery for a chronic disease. In this setting, patients periodically visit the healthcare delivery system, which influences their disease progression and consequently their health outcomes. We investigate how the provider can maximize community-level health outcomes through better operational decisions pertaining to capacity allocation across different patients. To do so, we develop an integrated capacity allocation model that incorporates clinical (disease progression) and operational (capacity constraint) aspects. Specifically, we model the provider's problem as a finite horizon stochastic dynamic program, where the provider decides which patients to schedule at the beginning of each period. Therapy is provided to scheduled patients, which may improve their health states. Patients that are not seen follow their natural disease progression. We derive a quantitative measure for comparison of patients' health states and use it to design an easy-to-implement myopic heuristic that is provably optimal in special cases of the problem. We employ the myopic heuristic in a more general setting and test its performance using operational and clinical data obtained from Mobile C.A.R.E. Foundation, a community-based provider of pediatric asthma care in Chicago. Our extensive computational experiments suggest that the myopic heuristic can improve the health gains at the community level by up to 15% over the current policy. The benefit is driven by the ability of our myopic heuristic to alter the duration between visits for patients with different health states depending on the tightness of the capacity and the health states of the entire patient population.
Background: There is scant evidence on the association between diagnosis delays and the receipt of test results in
HIV Early Infant Diagnosis (EID) programs. We determine the association between diagnosis delays and other health
care system and patient factors on result receipt.
Methods: We reviewed 703 infant HIV test records for tests performed between January 2008 and February 2009 at
a regional referral hospital and level four health center in Uganda. The main outcome was caregiver receipt of the
test result. The primary study variable was turnaround time (time between sample collection and result availability at
the health facility). Additional variables included clinic entry point, infant age at sample collection, reported HIV status
and receipt of antiretroviral prophylaxis for prevention of mother-to-child transmission. We conducted a pooled
analysis in addition to separate analyses for each facility. We estimated the relative risk of result receipt using
modified Poisson regression with robust standard errors.
Results: Overall, the median result turnaround time, was 38 days. 59% of caregivers received infant test results.
Caregivers were less likely to receive results at turnaround times greater than 49 days compared to 28 days or fewer
(ARR = 0.83; 95% CI = 0.70–0.98). Caregivers were more likely to receive results at the PMTCT clinic (ARR = 1.81;
95% CI = 1.40–2.33) and less likely at the pediatric ward (ARR = 0.54; 95% CI = 0.37–0.81) compared to the
immunization clinic. At the level four health center, result receipt was half as likely among infants older than 9 months
compared to 3 months and younger (ARR= 0.47; 95% CI = 0.25–0.93).
Conclusion: In this study setting, we find evidence that longer turnaround times, clinic entry point and age at sample
collection may be associated with receipt of infant HIV test results.