Deo, Sarang
Deo, Sarang
Associate Professor
Executive Director, Max Institute of Healthcare Management
Area Operations Management
Affiliation Indian School of Business
Email Sarang_Deo@isb.edu
SSRN ID
810962
Personal Webpage https://sites.google.com/a/isb.edu/sarangdeo/
- Overview
- Education
- Research
- Teaching
- In The Media
Sarang Deo is Associate 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.
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.
Ph D, UCLA Anderson School of Management
MBA, IIM Ahmedabad, India
B. Tech., IIT Bombay, India
Published Papers
Tuyet-Pho, Mai.,Deo, Sarang.,Palamountain, Kara.,Joloba, Moses Lutaakome.,Bajunirwe, Francis.,Katamba, Achilles. (2015) "Optimizing tuberculosis case detection through a novel diagnostic device placement model: The case of Uganda", PLOS ONE, 10 (4), e0122574Read Abstract >Close >Background
The Xpert MTB/RIF (Xpert) device is being widely adopted. Analysisis needed to guide the placement of devices within health systems to optimize tuberculosis (TB) detection.
Methods
We used epidemiologic and operational data from Uganda to perform a model-based comparison of different placement strategies for a limited number of Xpert devices, which included: 1) Health center level (sites ranked from highest to lowest level), 2) Smear volume (sites ranked from highest to lowest), 3) Antiretroviral therapy (ART) volume (sites ranked from greatest to least patients on ART), 4) External equality assessment (EQA) performance (sites ranked from worst to best smear microscopy performance) and 5) TB prevalence (sites ranked from highest to lowest). Outcomes included CDR, detection of multi-drug resistant TB, and number of sites requiring device placement.
Results
139 sites serving 87,600 TB suspects were modeled. Placement strategies that prioritized sites with higher TB prevalence and worse EQA performance led to a greater CDR compared to other strategies. They resulted in an incremental CDR of 4.9-12.3% compared to status quo (microscopy alone). Diagnosis of MDR-TB was greatest in the TB Prevalence strategy, with a 2.6-3.4% higher rate compared to the next best strategy. The number of Xpert devices required for the TB Prevalence, EQA Performance, and ART volume strategies was greater than the other strategies for the same level of coverage. Results remained robust over variation in clinical algorithm, EQA accuracy, and return for test results.
Conclusion
In Uganda, placement of Xpert devices in sites with high TB prevalence and poor EQA performance yielded the highest TB case detection rate. These results represent a novel use of program level data to inform the optimal placement of new technology in resource-constrained settings.
Deo, Sarang.,Rajaram, Kumar.,Rath, Sandeep.,Karmarkar, Uday.,Goetz, Matthew Bidwell. (Forthcoming) "Planning for HIV Screening, Testing and Care at the Veterans Health Administration", Operations Research, 63 (2), 287-304
Deo, Sarang.,Sohoni, Milind G. (2015) "Optimal Decentralization of Early Infant Diagnosis of HIV in Resource-Limited Settings.", M&SOM, 17 (2), 191-207Read Abstract >Close >Unavailability of appropriate diagnostic capability is a major constraint in scaling up HIV early infant diagnosis (EID) programs in resource-limited countries. Due to the complexity of the existing diagnostic technology, most EID networks are highly centralized with a few laboratories serving a large number of health facilities. This leads to long diagnostic delays and consequent failure of patients to collect results in a timely manner. Several point-of-care (POC) devices that provide rapid diagnosis within the health facilities are being developed to mitigate these drawbacks of the centralized EID networks. We argue that the decision of which facilities should receive the POC device (the placement plan) is critical to maximizing their public health impact in the presence of tight budget constraints. To formalize this argument, we develop an operational queueing network submodel that quantifies the impact of POC placement decision on the diagnostic delay and link it to a patient behavior submodel that quantifies the impact of diagnostic delay on the likelihood of result collection. We embed these two submodels within an optimization model that maximizes the number of patients receiving results, which has the structure of a nonlinear, nonseparable knapsack problem and is not amenable to exact analysis. Hence, we adopt a two-pronged solution approach. First, we approximate the patient behavior submodel with a piecewise linear relationship between the average diagnostic delay at a health facility and the fraction of results collected at that facility. We also approximate the operational dynamics using extant results on queueing networks with batched service and superposition of arrival streams. In addition, we use auxiliary variables and constraints to linearize the approximate formulation and use it to derive an ``optimal'' placement solution. Second, we develop a computational model by combining a detailed discrete event simulation of the exact operational dynamics with a Monte Carlo simulation of the exact patient behavior. We calibrate the computational model with data from the EID program in an East African country and evaluate the impact of the optimal allocation described above and two thumb rules that have practical appeal. We find that the optimal allocation can result in up to 30% more patients collecting their results compared to the thumb rules. A thumb rule that allocates POC devices to highest volume health facilities performs well if the accuracy of the POC device is sufficiently high and if patients are not very sensitive to delay. In contrast, a thumb rule of allocating POC devices to minimize average diagnostic delay in the network performs well if patients are very sensitive to delay. Finally, we show that the effectiveness of POC devices is much higher than other conventional interventions such as increased laboratory capacity, reduced transportation delay, and more regularized transport that are aimed at improving the laboratory network operations.
Salje, Henrik.,Andrews, Jason.,Deo, Sarang.,Satyanarayana, Srinath.,Pai, Madhukar.,Dowdy, David. (2014) "The Importance of Implementation Strategy in Scaling Up Xpert MTB/RIF for Diagnosis of Tuberculosis in the Indian Health-Care System: A Transmission Model", PLoS Medicine, 11 (7), e1001674
Deo, Sarang.,Iravani, Seyed.,Jiang, Tingting.,Smilowitz, Karen.,Samuelson, Stephen. (2013) "Improving health outcomes through better capacity allocation in a community-based chronic care model", Operations Research, 61 (6), 1277-1294Read Abstract >Close >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.
Sun, Amanda.,Pai, Madhukar.,Satyanarayana, Srinath.,Deo, Sarang.,Dowdy, David. (2013) "Modeling the Impact of Alternative Strategies for Rapid Molecular Diagnosis of Tuberculosis in Southeast Asia", American Journal of Epidemiology, 178 (12)
Allon, Gad.,Deo, Sarang.,Lin, Wuqin. (2013) "The impact of size and occupancy of hospital on the extent of ambulance diversion: Theory and evidence", Operations Research, 61 (3), 544-562
Latigo-Mugambi, Melissa.,Deo, Sarang.,Kekitiinwa, Adeodata.,Kiyaga, Charles.,Singer, Mendel. (2013) "Do health system delays impact patient retention? Evidence from HIV early infant diagnosis program in Uganda", PLoS One, 8 (11), e78891Read Abstract >Close >Abstract
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.
Arifoglu, Kenan.,Deo, Sarang.,Iravani, Seyed. (2012) "Consumption externality and yield uncertainty in influenza vaccine supply chain: Intervention on demand and supply side", Management Science, 58 (6), 1072-1091
Deo, Sarang.,Topp, Stephanie.,Westfall, Andrew O.,Wamulume, Chibesa M.,Morris, Mary.,Reid, Stewart. (2012) "Impact of organizational factors on quality of adult HIV lab testing in Lusaka, Zambia", BMC Health Services Research, 12 (106), 9
Deo, Sarang.,Topp, Stephanie.,Garcia, Ariel.,Yagci, Kezban.,Soldner, Mallory.,Reid, Stewart.,Chipukuma, Julien. (2012) "Modeling the impact of integrating HIV and outpatient health services on patient waiting times in an urban health clinic in Zambia", PLoS One, 7 (4), e35479
Deo, Sarang.,Gurvich, Itai. (2011) "Centralized vs. Decentralized Ambulance Diversion: A Network Perspective", Management Science, 57 (7), 1300-1319
Deo, Sarang.,Corbett, Charles J. (2009) "Cournot competition under yield uncertainty: The case of U.S. influenza vaccine market", Manufacturing & Service Operations Management, 11 (4), 563-576
Deo, Sarang.,Tang, Christopher S. (2008) "Rental price and rental duration under retail competition", European Journal of Operational Research, 187 (3), 806-828
Deo, Sarang.,McInnes, Keith.,Shapiro, Martin F.,Cleary, Paul D. (2008) "Assessing the impact of organizational factors on the performance of HIV clinics in quality improvement collaboratives", Medical Care, 47 (9), 929-1035
Deo, Sarang.,Tang, Christopher S. (2005) "Optimal procurement, disposal and pricing policies for managing rental goods", International Transactions In Operations Research, 12 (6), 595-629
Working Papers
Ganesh, Maya.,Deo, Sarang.,Devalkar, Sripad K. "IT enabled monitoring mechanisms in public sector supply chains: Evidence from the public distribution system in India"
Deo, Sarang.,Iravani, Seyed.,Jiang, Tingting.,Smilowitz, Karen. "Incentive design to coordinate disease management for chronic conditions"
Arifoglu, Kenan.,Deo, Sarang.,Iravani, Seyed. "Intertemporal Pricing and rationing of snob appeal products"
Deo, Sarang.,Jonassson, Jonas Oddur.,Gallien, Jeremie. "Improving HIV early infant diagnosis (EID) supply chains in sub-Saharan Africa"
Deo, Sarang.,Jain, Aditya.,Pendem, Pradeep. "Slow first, fast later: Empirical evidence of speed-up in service episodes of finite duration"
Deo, Sarang.,Corbett, Charles J.,Mehta, Sameer. "Dynamic resource allocation under supply uncertainty"
Deo, Sarang.,Gurvich, Itai.,Park, Eric. "Does limiting time on ambulance diversion reduce diversions? Signaling equilibrium and network effect"
Deo, Sarang.,Quevado, Jorge.,Crea, Lindy.,Lehe, Jonathan.,Vojnov, Lara.,Peter, Trevor.,Jani, Ilesh. "Expedited Results Delivery Systems using SMS technology Significantly Reduce Early Infant Diagnosis Test Turnaround Times"
Cases
Devalkar, Sripad K.,Deo, Sarang.,Vaidya, Akshay.,Gokhale, Meghana. "ATMYDOORSTEPS.COM: BREAKING GROUND IN THE ONLINE GROCERY MARKET IN INDIA", ISB Case Collection distributed through HBS Publishing, Forthcoming
Gambhir, Jagdeep Singh.,Deo, Sarang.,Sohoni, Milind G.,Arora, Priyank. "Aahan (A): Innovation in community delivery of TB care in India", HBS Case, 2013
Deo, Sarang.,Har, Avidan Ben.,Shields, Bill.,Naware, Mihir. "Infant HIV Diagnostics: Supply Chain in Sub-Saharan Africa", Kellogg School of Management, 2011Read Description >Close >Roger Osayende, a former management consultant, must advise the Ministry of Health of Ektu, a fictional country in Central Africa, on how to implement a new point-of-care diagnostic test for infants with HIV. In Ektu, mothers often transmitted HIV infection to infants during pregnancy, delivery, or breastfeeding due to inadequate resources to invest in prevention efforts. The existing procedure to diagnose infants with HIV required collecting dried blood samples at more than two hundred healthcare facilities around the country and transporting them to a central laboratory in the capital for testing. This process was characterized by significant delays due to long transportation times, batching of samples in transportation and processing in the lab, and concomitant congestion in the lab. This delay resulted in loss to follow-up, that is, lost patients due to mothers not collecting their infants' results. A new point-of-care device was about to be introduced, which would obviate the need for this centralized processing and the resulting diagnostic delay. The key decision under consideration is where to place the devices to maximize their effectiveness.
Deo, Sarang.,Smilowitz, Karen.,Stuewer, Kerry.,Kelly, Anne.,Schieneson, John.,Kim, Jason.,Asvatanakul, Thepphan. "Mobile C.A.R.E. Foundation", Kellogg School of Management, 2011Read Description >Close >Mobile C.A.R.E. Foundation is a Chicago-based nonprofit that provides chronic asthma care to inner-city public school students using a community outreach model. The organization faces a lot of uncertainty in future funding, and executive director Steve Samuelson wants to undertake an operational improvement drive. Samuelson now faces the challenge of deciding which operational metrics most closely correlate with the organization's mission metrics and also have the usual desirable properties of process measures: actionable, real-time, and disaggregate.
Deo, Sarang.,Kolesov, Ilya.,Waikar, Sachin.,Richardson, Hilary. "Optimizing Flu Vaccine Planning at NorthShore University", Kellogg School of Management, 2011
Deo, Sarang.,Corbett, Charles.,Tempelman, Hugo.,Slabbert, Mariette. "Ndlovu: The clock ticks!", UCLA Anderson School of Management, 2010Read Description >Close >This case discusses the situation at Ndlovu Care Group (NCG) in July 2008. The group, founded by Dutch social entrepreneur Dr Hugo Tempelman, has been running a very successful health care facility – Ndlovu Medical Center (NMC) – in the township of Elandsdoorn in rural South Africa. The case discusses NCG’s plans to expand that success to other locations in the country. At the time of the case, Dr Tempelman had just received a major grant from the Dutch embassy in South Africa to fund his expansion plans. This provides a perfect opportunity to discuss questions about how to replicate an intricate organization that has taken some 15 years to build, and whether that is even possible; what management structure is needed to oversee that replication; what risks are involved and how they might be mitigated. The need to balance increased professionalization with maintaining the founder’s passion runs as a thread through the case.
Deo, Sarang.,Singh, Sanjay Kumar.,G, Raghuram.,Choudhari, Sanjay. "Adani Wilmar Limited", Asian Case Research Journal, 2009Read Description >Close >The total size of the edible oils market in India was estimated to be 13 million tons (mt) out of which imports amounted to about 4 mt. This made India the largest importer of edible oils in the world. Various edible oils are consumed in the India depending on the regional tastes and preferences. A differential in the duties on oil seed and oils made it favorable to import edible oils instead of oilseeds. Similarly, a differential duty between the refined oil and the raw oil encouraged the import of raw oil in order to support the domestic refineries.
Adani Wilmar Limited (AWL) was a part of the Adani group, which started as a trading company mainly into exports of commodities. The group had recently entered into the infrastructure sector with the building of the Mundra port. The group had formed a joint venture with Wilmar Trading of Singapore to enter into the edible oil business. The company was setting up a refinery with capacity of 600 tons per day. It planned to sell half of the production as bulk oil and the rest as packed oil. The company viewed supply chain management as one of the important means to get a competitive edge. Approximately 70% of the total logistics cost was accounted for by transportation cost. Some of the key decisions the company faced was the location of the warehouses, mode choice and routing.
Courses Taught
Statistical Methods for Management Decisions
Designing and Managing Effective Healthcare Delivery Systems
Statistical Analysis 1: Estimation and Testing
Designing and Managing Effective Healthcare Delivery Systems
Deo, Sarang (2012), Using Operations Management to Improve Healthcare Access, ISB Insight, December 31, 2012
Deo, Sarang (2012), When Hospitals Turn Away Ambulances, Kellogg Insight, June 04, 2012
Deo, Sarang (2012), Accel Partners, IDG Ventures to invest $5 million in Forus Health, Economic Times, May 01, 2012
Deo, Sarang (2011), Decentralization of resource-constrained networks, Pharmabiz, October 20, 2011
Deo, Sarang (2011), A Potentially Fatal Illness, An Unpredictable Vaccine, Kellogg Insight, April 01, 2011
Deo, Sarang (2009), Rational Rationing, Kellogg Insight, December 01, 2009