Improving Health Outcomes Through Better Capacity Allocation in a Community-Based Chronic Care Model
By Sarang Deo, Seyed Iravani, Tingting Jiang, Karen Smilowitz, Stephen Samuelson
Operations Research | December 2013
DOI
doi.org/10.1287/opre.2013.1214
Citation
Deo, Sarang., Iravani, Seyed., Jiang, Tingting., Smilowitz, Karen., Samuelson, Stephen. Improving Health Outcomes Through Better Capacity Allocation in a Community-Based Chronic Care Model Operations Research doi.org/10.1287/opre.2013.1214.
Copyright
Operations Research, 2013
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Abstract
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.

Sarang Deo is a Professor of Operations Management at the Indian School of Business (ISB). He also serves as the Executive Director of the ISB’s Max Institute of Healthcare Management, where he provides strategic leadership for ISB's healthcare initiatives through interdisciplinary research, education, and collaboration.

Professor Deo's research focuses on healthcare delivery systems, examining how operational decisions influence population-level health outcomes. His work spans a wide range of healthcare contexts, including influenza vaccine supply chains and ambulance diversion in the United States, HIV early infant diagnosis networks in sub-Saharan Africa, and formal and informal pathways for tuberculosis (TB) diagnosis and treatment in India. His recent research has focused on designing and evaluating healthcare delivery models, with a particular emphasis on digital health and the integration of artificial intelligence into healthcare systems.

He regularly collaborates with leading global health organisations, including the Gates Foundation, the Clinton Health Access Initiative (CHAI), and PATH. He currently serves on the World Health Organization's Strategic and Technical Advisory Group for Tuberculosis (STAG-TB) and the Working Group for Non-Technical Evaluation under the WHO Global Initiative on AI for Health (GI-AI4H).

Prior to joining ISB, Professor Deo was an Assistant Professor at the Kellogg School of Management. He holds a PhD from the UCLA Anderson School of Management, an MBA from the Indian Institute of Management Ahmedabad, and a BTech from the Indian Institute of Technology Bombay. Before entering academia, he worked as a management consultant with Accenture.

Professor Sarang Deo
Sarang Deo