Title : Advanced visual tool for the collaborative replanning of service delivery at home: application to home health care



Project Lead : Lanzarone Ettore From : Istituto di Matematica Applicata e Tecnologie Informatiche (IMATI) sezione di Milano, Consiglio Nazionale delle Ricerche (None)

Dates : from -- to 2014-11-28 14:38:59

Description :

Motivation and objectives :
The delivery of services and goods at customers' homes is getting more and more important in several fields. In general, for commercial products, the growing of the service is due to the increasing number of online purchasing of goods. Such home delivery is highly important also in the health care sector, where Home Care (HC) services are continuously growing in western countries, because they increase the quality of life of the assisted patients and they allow relevant cost savings the National Health Care Systems. Indeed, HC includes medical, paramedical and social services that are delivered to patients in their homes. The purpose of HC is to alleviate the pain of the assisted patients and to improve or sustain their health and quality of life. The main benefit of HC is a decrease in the hospitalization rate, leading to both significant increases in the quality of life for patients and relevant cost savings in the health care system. This service is a relevant and growing sector in the healthcare domain of western countries because of the ageing of the population, the increase in chronic pathologies, the introduction of innovative technologies and the continuous pressure of governments to contain healthcare costs. Such service is representative of a general class of home delivery services. Moreover, it is characterized by several peculiarities that make HC one of the more complex services of this type, e.g., the high uncertainty that affect HC demand and the need to repeat several treatments to the same patient. Thus, the possibility of creating tools for the optimization of HC services is twice important. On one side, this helps the economical sustainability of HC and the possibility of increasing this service within the health care domain. On the other, the tools developed for this service can be reused in other home delivery services with the same structure. Many resources are involved in service delivery, including different categories of operators (e.g., nurses, physicians, physiotherapists, social assistants and psychologists), support staff and material resources. Patients are classified into different categories and each category includes a certain number of Care Profiles (CPs) based on specific needs, the level of requirement and the costs associated with the provided services. Patients need to be cared for by different categories of operators: they are always under the charge of the nurses and, in some cases, of other operators. Within each category, operators are divided into districts: they take care of patients belonging to CPs that they are skilled for and, in large HC providers, they are divided into territorial groups and take care (only or preferably, according to the provider policy) of patients who are resident in their territory. Some HC providers pursue the continuity of care, i.e., patients are assigned to only one operator for each category, named reference operator, who follows the entire patient care pathway and preferably provides all of the visits that are pertinent to his/her category. The continuity of care is an important quality indicator of the HC service because the quality perceived by the patient is preserved when he/she receives care from the same person and, thus, he/she does not have to continuously change his/her relationship with a new operator. This project focuses on facilitating and optimizing the planning and management of home delivery services, with particular reference to HC human resources. Specifically, the planning of nurses' activities is analyzed. Such planning requires two main levels. A static planning of nurses' activities at the beginning of a time period (usually, the week) and a dynamic replanning of such activities during the delivering to compensate for disrupting events that alter the plans and mine their feasibility. I previously developed a set of methodologies to address the static planning of nurses. In particular, some tools to solve the nurse-to-patient assignment problem have been developed, with the main goal of balancing the workloads among the nurses, under the constraint of satisfying the care volume necessary to the patients under the charge and preserving the continuity of care. Moreover, given the necessity of estimating the demand from the patients under the charge during the planning period, a stochastic model that describes the evolution of a patient's conditions and provides estimates on the amount of visits required during his/her stay was also developed. As for the dynamic replanning, this cannot be faced by automatic tools based on programming or simulation models. This holds for main two reasons. On one side, some constraints are usually violated when a replanning is required, and a deep evaluation of the impact of such violation is fundamental and cannot be in charge of only a mathematical tool. On the other side, the sudden replanning may require to integrate the knowledge of the planners, which is not formalized into the data used for the static planning. For such replanning activity, planners of home delivery services, and in particular of HC human resources, have to manage a large amount of data. In the case of HC, these data are related to skill compatibilities between patients and operators, territorial distribution of patients and operators, information related to the continuity of care (i.e., the reference nurse of each patient), patients' demands and, consequently, operators' workload, schedules of visits, ... In particular, as regards demands and workloads, information to be managed includes the estimates of these variables over the planning period of the provider. These estimates are in terms of probability density functions, from which significant parameters have to be extracted. As for the static planning, the large amount of data is processed by programming tools. However, for the daily dynamic replanning, a human processing of the data is required and the possibility that planners effectively manage this large amount of data is highly limited by the poor visualization of these data provided by standard software applications. As example, two tabular visualizations of data provided by a commercial tool for HC human resource planning are available at: http://www.mi.imati.cnr.it/~ettore/attached/Figure1.png http://www.mi.imati.cnr.it/~ettore/attached/Figure2.png In small situations, with a limited number of variables, the replanning can be carried out by only one planner. However, in case of middle and large HC providers with a pool of planners, or in cases where planners work in shifts, the possibility to share information and to work in a collaborative context are highly important for an effective replanning that minimizes patients' discomforts and the costs sustained by the HC provider to implement the replanning. In a previous Visionair TNA project (project no. 29), we develop a prototypal tool for helping planners during the replanning phase. The main specifications of the tool have been defined, and the tool has been developed and partially validated. In particular the first level of usability, i.e., the capability to display the requested information and to interact with them has been assessed. That project enabled us to define and implement a usable metaphor, and to redefine the operations related to the replanning activity. The tool and the first validation performed on it have been satisfactory, and give the basis for a future development of the research, as described in the next section, which is the aim of this second project.

Teams :
The IMATI-MILANO research unit is established within the Milan department of the Institute of Applied Mathematics and Information Technology "Enrico Magenes" of the Italian National Research Council (CNR).

Dates :
starting date : 03 April, 2014
ending date : 25 April, 2014

Facilities descriptions :
http://visionair-browser.g-scop.grenoble-inp.fr/visionair/Browser/Catalogs/MEXICO.FR.html

Recordings & Results :
The delivery of services and goods at customers' homes is getting more and more important in several fields. In general, for commercial products, the growing of the service is due to the increasing number of online purchasing of goods. Such home delivery is highly important also in the health care sector, where Home Care (HC) services are continuously growing in western countries, because they increase the quality of life of the assisted patients and they allow relevant cost savings the National Health Care Systems. This project focuses on facilitating and optimizing the planning and management of home delivery services, with particular reference to HC human resources. Specifically, the planning of nurses' activities is analyzed.

Conclusions :
All 3 phases of the project have been completed successfully, and a scientific paper has been written from this research (CogInfoCom 2014).




Project Images :

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