A decision support tool for the location, districting and dimensioning of Community Health Houses.

IF 2.8 3区 医学 Q2 HEALTH POLICY & SERVICES
Health Care Management Science Pub Date : 2025-12-01 Epub Date: 2025-11-10 DOI:10.1007/s10729-025-09729-3
Martina Doneda, Ettore Lanzarone, Carlotta Franchi, Sara Mandelli, Angelo Barbato, Alessandro Nobili, Giuliana Carello
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引用次数: 0

Abstract

Community Health Houses (CHHs) are new entities in the Italian National Health Service that have been envisaged to provide proximity care to an increasingly aging population, and bear some similarities to other facilities in countries that have historically focused on public healthcare. This work proposes an integrated decision support system (DSS) for their planning, envisioned during the aftermath of the COVID-19 pandemic, which highlighted the frailty of the existing system. The DSS is based on an integer linear programming (ILP) model that simultaneously makes location, districting and dimensioning decisions for CHH, and accounts for accessibility and equity requirements. Based on Italian law yet designed in a parametrized way that makes it adaptable to several contexts, the DSS is able to design a hub and spoke network, which considers the provision of both mandatory and additional services. The sizes of the former are determined by directly taking into account the population served, while those of the latter are determined according to the specific demand for these services, accounting for diverse needs arising from different territories. The DSS also uses territorial units that refer to recognizable administrative areas. This ensures that the districting is easily recognized and accepted by the population. In addition to the ILP formulation, three decomposition-based matheuristics are proposed, which allow suitable solutions to be found within a reasonable time also for large and heterogeneous instances, while maintaining the flexibility of the ILP formulation. Computational results on synthetic realistic instances validated the DSS, while its application to a real-life case in a Northern Italian province demonstrated the effectiveness of the heuristic approaches and provided a proof of concept for its practical application.

社区卫生院选址、分区和规划的决策支持工具。
社区卫生院(CHHs)是意大利国家卫生服务机构的新实体,旨在为日益老龄化的人口提供近距离护理,与历史上专注于公共卫生保健的国家的其他设施有一些相似之处。这项工作为他们的规划提出了一个综合决策支持系统(DSS),这是在2019冠状病毒病大流行之后设想的,这凸显了现有系统的脆弱性。DSS基于整数线性规划(ILP)模型,该模型同时为CHH做出位置、分区和尺寸决策,并考虑可达性和公平性要求。DSS以意大利法律为基础,以参数化的方式设计,使其适应多种情况,能够设计一个枢纽和辐条网络,考虑提供强制性和额外的服务。前者的规模是直接考虑到所服务的人口而决定的,而后者的规模是根据对这些服务的具体需求而决定的,考虑到不同地区产生的不同需求。DSS还使用领土单位来指代可识别的行政区域。这确保了分区容易被人们认可和接受。除了ILP公式外,还提出了三种基于分解的数学方法,这使得在合理的时间内找到适合的解决方案,也适用于大型和异构实例,同时保持ILP公式的灵活性。综合现实实例的计算结果验证了DSS,而其在意大利北部省份的实际案例中的应用表明了启发式方法的有效性,并为其实际应用提供了概念证明。
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来源期刊
Health Care Management Science
Health Care Management Science HEALTH POLICY & SERVICES-
CiteScore
7.20
自引率
5.60%
发文量
40
期刊介绍: Health Care Management Science publishes papers dealing with health care delivery, health care management, and health care policy. Papers should have a decision focus and make use of quantitative methods including management science, operations research, analytics, machine learning, and other emerging areas. Articles must clearly articulate the relevance and the realized or potential impact of the work. Applied research will be considered and is of particular interest if there is evidence that it was implemented or informed a decision-making process. Papers describing routine applications of known methods are discouraged. Authors are encouraged to disclose all data and analyses thereof, and to provide computational code when appropriate. Editorial statements for the individual departments are provided below. Health Care Analytics Departmental Editors: Margrét Bjarnadóttir, University of Maryland Nan Kong, Purdue University With the explosion in computing power and available data, we have seen fast changes in the analytics applied in the healthcare space. The Health Care Analytics department welcomes papers applying a broad range of analytical approaches, including those rooted in machine learning, survival analysis, and complex event analysis, that allow healthcare professionals to find opportunities for improvement in health system management, patient engagement, spending, and diagnosis. We especially encourage papers that combine predictive and prescriptive analytics to improve decision making and health care outcomes. The contribution of papers can be across multiple dimensions including new methodology, novel modeling techniques and health care through real-world cohort studies. Papers that are methodologically focused need in addition to show practical relevance. Similarly papers that are application focused should clearly demonstrate improvements over the status quo and available approaches by applying rigorous analytics. Health Care Operations Management Departmental Editors: Nilay Tanik Argon, University of North Carolina at Chapel Hill Bob Batt, University of Wisconsin The department invites high-quality papers on the design, control, and analysis of operations at healthcare systems. We seek papers on classical operations management issues (such as scheduling, routing, queuing, transportation, patient flow, and quality) as well as non-traditional problems driven by everchanging healthcare practice. Empirical, experimental, and analytical (model based) methodologies are all welcome. Papers may draw theory from across disciplines, and should provide insight into improving operations from the perspective of patients, service providers, organizations (municipal/government/industry), and/or society. Health Care Management Science Practice Departmental Editor: Vikram Tiwari, Vanderbilt University Medical Center The department seeks research from academicians and practitioners that highlights Management Science based solutions directly relevant to the practice of healthcare. Relevance is judged by the impact on practice, as well as the degree to which researchers engaged with practitioners in understanding the problem context and in developing the solution. Validity, that is, the extent to which the results presented do or would apply in practice is a key evaluation criterion. In addition to meeting the journal’s standards of originality and substantial contribution to knowledge creation, research that can be replicated in other organizations is encouraged. Papers describing unsuccessful applied research projects may be considered if there are generalizable learning points addressing why the project was unsuccessful. Health Care Productivity Analysis Departmental Editor: Jonas Schreyögg, University of Hamburg The department invites papers with rigorous methods and significant impact for policy and practice. Papers typically apply theory and techniques to measuring productivity in health care organizations and systems. The journal welcomes state-of-the-art parametric as well as non-parametric techniques such as data envelopment analysis, stochastic frontier analysis or partial frontier analysis. The contribution of papers can be manifold including new methodology, novel combination of existing methods or application of existing methods to new contexts. Empirical papers should produce results generalizable beyond a selected set of health care organizations. All papers should include a section on implications for management or policy to enhance productivity. Public Health Policy and Medical Decision Making Departmental Editors: Ebru Bish, University of Alabama Julie L. Higle, University of Southern California The department invites high quality papers that use data-driven methods to address important problems that arise in public health policy and medical decision-making domains. We welcome submissions that develop and apply mathematical and computational models in support of data-driven and model-based analyses for these problems. The Public Health Policy and Medical Decision-Making Department is particularly interested in papers that: Study high-impact problems involving health policy, treatment planning and design, and clinical applications; Develop original data-driven models, including those that integrate disease modeling with screening and/or treatment guidelines; Use model-based analyses as decision making-tools to identify optimal solutions, insights, recommendations. Articles must clearly articulate the relevance of the work to decision and/or policy makers and the potential impact on patients and/or society. Papers will include articulated contributions within the methodological domain, which may include modeling, analytical, or computational methodologies. Emerging Topics Departmental Editor: Alec Morton, University of Strathclyde Emerging Topics will handle papers which use innovative quantitative methods to shed light on frontier issues in healthcare management and policy. Such papers may deal with analytic challenges arising from novel health technologies or new organizational forms. Papers falling under this department may also deal with the analysis of new forms of data which are increasingly captured as health systems become more and more digitized.
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