Applying operations research to optimize a novel population management system for cancer screening

Abstract

Objective: To optimize a new visit-independent, population-based cancer screening system (TopCare) by using operations research techniques to simulate changes in patient outreach staffing levels (delegates, navigators), modifications to user workflow within the information technology (IT) system, and changes in cancer screening recommendations.

Materials and methods: TopCare was modeled as a multiserver, multiphase queueing system. Simulation experiments implemented the queueing network model following a next-event time-advance mechanism, in which systematic adjustments were made to staffing levels, IT workflow settings, and cancer screening frequency in order to assess their impact on overdue screenings per patient.

Results: TopCare reduced the average number of overdue screenings per patient from 1.17 at inception to 0.86 during simulation to 0.23 at steady state. Increases in the workforce improved the effectiveness of TopCare. In particular, increasing the delegate or navigator staff level by one person improved screening completion rates by 1.3% or 12.2%, respectively. In contrast, changes in the amount of time a patient entry stays on delegate and navigator lists had little impact on overdue screenings. Finally, lengthening the screening interval increased efficiency within TopCare by decreasing overdue screenings at the patient level, resulting in a smaller number of overdue patients needing delegates for screening and a higher fraction of screenings completed by delegates.

Conclusions: Simulating the impact of changes in staffing, system parameters, and clinical inputs on the effectiveness and efficiency of care can inform the allocation of limited resources in population management.

Keywords: cancer screening, preventive screening; electronic medical records, electronic health records; operations research, queue, queuing theory; optimization, optimize limited resources; population management, registries; simulation, simulation modeling.

Figure 1

Activity diagram of the redesigned workflow for population-based cancer screening.

Figure 2

Trajectories of average number of overdue screenings per patient (A) and SE of CI (B).

Figure 3

Box plots illustrating the relationship between average number of overdue screenings per patient and staff levels of TopCare delegates (A) or TopCare navigators (B) (with the upper and lower bounds of 95% CI attached).

Figure 4

Box plots showing the impact of changing navigator staff levels on fraction of high-risk patients’ screenings completed per year (with the upper and lower bounds of 95% CI attached).