Planning a Community Approach to Diabetes Care in Low- and Middle-Income Countries Using Optimization
By Katherine B. Adams, Justin J. Boutilier, Sarang Deo, Yonatan Mintz
Cornell University
DOI
arxiv.org/abs/2305.06426
Citation
B. Adams, Katherine., J. Boutilier, Justin., Deo, Sarang., Mintz, Yonatan. (2023). Planning a Community Approach to Diabetes Care in Low- and Middle-Income Countries Using Optimization Cornell University arxiv.org/abs/2305.06426.
Copyright
Cornell University, 2023
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Abstract
Diabetes is a global health priority, especially in low- and-middle-income countries, where over 50% of premature deaths are attributed to high blood glucose. Several studies have demonstrated the feasibility of using Community Health Worker (CHW) programs to provide affordable and culturally tailored solutions for early detection and management of diabetes. Yet, scalable models to design and implement CHW programs while accounting for screening, management, and patient enrollment decisions have not been proposed. We introduce an optimization framework to determine personalized CHW visits that maximize glycemic control at a community-level. Our framework explicitly models the trade-off between screening new patients and providing management visits to individuals who are already enrolled in treatment. We account for patients' motivational states, which affect their decisions to enroll or drop out of treatment and, therefore, the effectiveness of the intervention. We incorporate these decisions by modeling patients as utility-maximizing agents within a bi-level provider problem that we solve using approximate dynamic programming. By estimating patients' health and motivational states, our model builds visit plans that account for patients' tradeoffs when deciding to enroll in treatment, leading to reduced dropout rates and improved resource allocation. We apply our approach to generate CHW visit plans using operational data from a social enterprise serving low-income neighborhoods in urban areas of India. Through extensive simulation experiments, we find that our framework requires up to 73.4% less capacity than the best naive policy to achieve the same performance in terms of glycemic control. Our experiments also show that our solution algorithm can improve upon naive policies by up to 124.5% using the same CHW capacity.

Sarang Deo is a Professor of Operations Management at the Indian School of Business (ISB), where he also serves as the Deputy Dean for Faculty and Research and as the Executive Director of the Max Institute of Healthcare Management (MIHM).

His primary area of research is health care delivery systems. He is interested in investigating the impact of operations decisions on population-level health outcomes. Some of the healthcare contexts that he has studied include the influenza vaccine supply chain and the phenomenon of ambulance diversion in the US, HIV early infant diagnosis networks in sub-Saharan Africa, and formal and informal pathways for tuberculosis (TB) diagnosis in India. He regularly collaborates with international public health funding and implementation agencies such as Bill & Melinda Gates Foundation (BMGF), Clinton Health Access Initiative (CHAI), and PATH for his research. He currently serves as a member of the WHO Strategic and Technical Advisory Group on TB (STAG-TB).

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

Sarang Deo
Sarang Deo