Resource Allocation with Sigmoidal Demands: Mobile Healthcare Units and Service Adoption

2021 ◽  
Author(s):  
Andres Alban ◽  
Philippe Blaettchen ◽  
Harwin de Vries ◽  
Luk N. Van Wassenhove
Keyword(s):  
Health Services ◽  
Optimal Allocation ◽  
Formal Model ◽  
Problem Definition ◽  
Gradient Boosting ◽  
Access To Health Services ◽  
Mobile Healthcare ◽  
Sigmoidal Functions ◽  
Allocation Decisions

Problem definition: Achieving broad access to health services (a target within the sustainable development goals) requires reaching rural populations. Mobile healthcare units (MHUs) visit remote sites to offer health services to these populations. However, limited exposure, health literacy, and trust can lead to sigmoidal (S-shaped) adoption dynamics, presenting a difficult obstacle in allocating limited MHU resources. It is tempting to allocate resources in line with current demand, as seen in practice. However, to maximize access in the long term, this may be far from optimal, and insights into allocation decisions are limited. Academic/practical relevance: We present a formal model of the long-term allocation of MHU resources as the optimization of a sum of sigmoidal functions. We develop insights into optimal allocation decisions and propose pragmatic methods for estimating our model’s parameters from data available in practice. We demonstrate the potential of our approach by applying our methods to family planning MHUs in Uganda. Methodology: Nonlinear optimization of sigmoidal functions and machine learning, especially gradient boosting, are used. Results: Although the problem is NP-hard, we provide closed form solutions to particular cases of the model that elucidate insights into the optimal allocation. Operationalizable heuristic allocations, grounded in these insights, outperform allocations based on current demand. Our estimation approach, designed for interpretability, achieves better predictions than standard methods in the application. Managerial implications: Incorporating the future evolution of demand, driven by community interaction and saturation effects, is key to maximizing access with limited resources. Instead of proportionally assigning more visits to sites with high current demand, a group of sites should be prioritized. Optimal allocation among prioritized sites aims at equalizing demand at the end of the planning horizon. Therefore, more visits should generally be allocated to sites where the cumulative demand potential is higher and counterintuitively, often those where demand is currently lower.

Modeling Dependencies in Engineering Design

1999 ◽  
Author(s):  
Kai-Lu Wang ◽  
Yan Jin
Keyword(s):  
Engineering Design ◽  
Collaborative Design ◽  
Formal Model ◽  
Problem Definition ◽  
Current Status ◽  
Collaborative Engineering ◽  
Engineering Research ◽  
Detail Design ◽  
Support Tools

Abstract Collaborative engineering design involves coordination among designers. While coordination in most cases entails explicit communication between designers, the real reason for designers to coordinate with each other is not for communication but for resolving engineering dependencies. In the field of collaborative engineering research, various computer models and tools have been developed to facilitate communication among designers aiming to improve their communication efficiency for coordination. We argue that in order to provide effective and purposeful coordination support, one must understand how engineering dependencies evolve and propagate in different phases, of design, from problem definition, conceptual design, to detail design. In our research on collaborative design, we take a dependency-based approach, i.e., to explicitly capture and manipulate dependencies and create design processes and support tools based on explicit understanding of underlying dependencies. The long term goal of our research is to develop a dependency-based coordination framework that consists of a formal model of engineering dependencies and coordination mechanisms, mapping between the dependencies and coordination methods, and guidelines and procedures for dependency-based work process design and management. This paper describes our current status of developing a formal model of engineering dependencies.

scholarly journals The Quest to Extend Health Services to Vulnerable Substance Users in Rio de Janeiro, Brazil in the Context of an Unfolding Economic Crisis

2016 ◽  
Vol 47 (3) ◽  
pp. 477-488 ◽  
Author(s):  
Noa Krawczyk ◽  
Deanna Kerrigan ◽  
Francisco Inácio Bastos
Keyword(s):  
Health Services ◽  
Health System ◽  
Economic Crisis ◽  
Rio De Janeiro ◽  
Crack Cocaine ◽  
Access To Health Services ◽  
Government Programs ◽  
Substance Users ◽  
Unified Health System ◽  
Harsh Criticism

Calls to address crack-cocaine use in Brazil among homeless and street-frequenting populations who are in urgent need of health services have questioned the capacity of the Brazilian Unified Health System to attend to the nation’s most marginalized citizens. In recent years, Brazil has launched several actions to escalate care for substance users, yet many obstacles hindering accessibility and effectiveness of services remain. Paradoxically, these actions have been implemented in the context of a growing economic crisis, and expanding services for a population of poor and stigmatized substance users while cutting other government programs tends to elicit harsh criticism from citizens. In consequence of such prospects, this commentary aims to discuss barriers marginalized substance users face in accessing health services that are at risk of worsening with government cutbacks. Using Rio de Janeiro as an example, we explore two primary issues: the resource-strained, under-staffed and decentralized nature of the Brazilian Unified Health System and the pervading stigma that bars vulnerable citizens from official structures and services. Abandoning initiated government efforts to increase access to health services would risk maintaining vulnerable citizens at the margins of public structures, inhibiting the opportunity to offer this population humane and urgently needed treatment and care.

scholarly journals It Is Not Just Mortality: A Call From Chile for Comprehensive COVID-19 Policy Responses Among Older People

2020 ◽  
Author(s):  
Pablo Villalobos Dintrans ◽  
Jorge Browne ◽  
Ignacio Madero-Cabib
Keyword(s):  
Older People ◽  
National Level ◽  
Health Issues ◽  
Negative Consequences ◽  
Access To Health Services ◽  
Term Care ◽  
Policy Responses ◽  
Level Data ◽  
Definition Of

Abstract Objective Provide a synthesis of the COVID-19 policies targeting older people in Chile, stressing their short- and long-term challenges. Method Critical analysis of the current legal and policy measures, based on national-level data and international experiences. Results Although several policies have been enacted to protect older people from COVID-19, these measures could have important unintended negative consequences in this group’s mental and physical health, as well as financial aspects. Discussion A wider perspective is needed to include a broader definition of health—considering financial scarcity, access to health services, mental health issues, and long-term care—in the policy responses to COVID-19 targeted to older people in Chile.

scholarly journals Implications for health services

1997 ◽  
Vol 352 (1363) ◽  
pp. 1887-1893 ◽  
Author(s):  
John Grimley Evans
Keyword(s):  
Health Services ◽  
Political Thought ◽  
Elderly Population ◽  
Average Duration ◽  
Later Life ◽  
The Elderly ◽  
Services Research ◽  
Extrinsic Factors ◽  
Progressive Loss

Health services for older people in the NHS have developed pragmatically, and reflect the nature of disease in later life and the need to agree objectives of care with patients. Although services are likely to be able to cope with the immediate future, the growth of the elderly population anticipated from 2030 calls for long–term planning and research. The issue of funding requires immediate political thought and action. Scientifically the focus needs to be on maximizing the efficiency of services by health services research and reducing the incidence of disability in later life through research on its biological and social determinants. Senescence is a progressive loss of adaptability due to an interaction between intrinsic (genetic) processes with extrinsic factors in environment and lifestyle. There are grounds for postulating that a policy of postponement of the onset of disability, by modifications of lifestyle and environment, could reduce the average duration of disability before death. The new political structures of Europe offer underexploited–unexploited opportunities for the necessary research.

Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study

The Lancet ◽  
2012 ◽  
Vol 379 (9818) ◽  
pp. 805-814 ◽  
Author(s):  
Qun Meng ◽  
Ling Xu ◽  
Yaoguang Zhang ◽  
Juncheng Qian ◽  
Min Cai ◽  
...  
Keyword(s):  
Health Services ◽  
Cross Sectional Study ◽  
Financial Protection ◽  
Sectional Study ◽  
Access To Health Services ◽  
Cross Sectional ◽  
Access To Health

Development, implementation and evaluation of nurse-led integrated, person-centred care with long-term conditions

2017 ◽  
Vol 25 (3) ◽  
pp. 186-195 ◽  
Author(s):  
Clare Lynette Harvey ◽  
Jonathan Sibley ◽  
Janine Palmer ◽  
Andrew Phillips ◽  
Eileen Willis ◽  
...  
Keyword(s):  
Health Services ◽  
Chronic Conditions ◽  
Well Being ◽  
Multiple Chronic Conditions ◽  
Long Term Conditions ◽  
Content Type ◽  
Care Services ◽  
Health Strategy ◽  
Global Increase

Purpose The purpose of this paper is to outline a conceptual plan for innovative, integrated care designed for people living with long-term conditions (LTCs). Design/methodology/approach The conceptual plan delivers a partnership between the health system, the person with LTCs (chronic), their family, and the community. The partnership aims to support people at home with access to effective treatment, consistent with the New Zealand Government Health Strategy. This concept of people-owned care is provided by nurses with advanced practice skills, who coordinate care across services, locations and multiple LTCs. Findings With the global increase in numbers of people with multiple chronic conditions, health services are challenged to deliver good outcomes and experience. This model aims to demonstrate the effective use of healthcare resources by supporting people living with a chronic condition, to increase their self-efficacy and resilience in accordance with personal, cultural and social circumstance. The aim is to have a model of care that is replicable and transferable across a range of health services. Social implications People living with chronic conditions can be empowered to manage their health and well-being, whilst having access to nurse-led care appropriate to individual needs. Originality/value Although there are examples of case management and nurse-led coordination, this model is novel in that it combines a liaison nursing role that works in partnership with patients, whilst ensuring that care across a number of primary and secondary care services is truly integrated and not simply interfaced.

scholarly journals Patient adherence to ischemic heart disease treatment

2017 ◽  
Vol 63 (3) ◽  
pp. 252-260 ◽  
Author(s):  
Moacyr Roberto Cuce Nobre ◽  
Rachel Zanetta de Lima Domingues
Keyword(s):  
Heart Disease ◽  
Health Services ◽  
Ischemic Heart Disease ◽  
Patient Adherence ◽  
Ischemic Heart ◽  
Sociocultural Factors ◽  
Multidisciplinary Teams ◽  
Access To Health Services ◽  
Cross Sectional ◽  
Caregiver Support

Summary Introduction: The effectiveness of the treatment of chronic diseases depends on the participation of the patient, influenced by different sociocultural factors, which are not fully recognized by the treatment routine. Objective: To search for some of these factors that hinder or facilitate adherence to treatment and use of healthcare resources, approaching patients with ischemic heart disease. Method: A cross-sectional study was conducted using face-to-face interviews. We applied semi-structured questionnaires to 347 individuals and recorded 141 interviews for qualitative analysis. Descriptors were selected to identify eight categories of analyses. The quantitative data were submitted to descriptive analysis of frequency. Results: Only 2% had good medication adherence according to score on Morisky questionnaire. About 23% bought statins; the others obtained statin in the public health institution. Thirty-six speeches were selected and classified according to the following categories: knowledge about disease and medication, difficulty of acquisition, self management of treatment, difficulties of access to health services, side effect of statins, caregiver support, transportation to health services and concerns about the disease progression. However, it was noticed that about 1/3 of the care outside the research institution can be characterized as an attempt to bring rationalization to the health system. Conclusion: The improved adherence to chronic treatment of ischemic heart disease depends on the establishment of effective flows for referral and counter-referral from one care unit to another, relevant information and clarification of the questions for the patients and the attention of health professionals to the many social and cultural factors involved in treatment adherence. New research should be focused on educational groups by integrated multidisciplinary teams in order to share treatment decisions, thereby increasing the patient's commitment to his own health.

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