Operations research optimizes population-based cancer screening systems

The allocation of limited resources in population management can be bettered by the simulation of the impact of changes in staffing, system parameters, and clinical inputs on the effectiveness and efficiency of care, according to a study published in the February 2014 issue of the Journal of the American Medical Informatics Association.

Institutions have recently been employing health IT systems that are based on population perspective and allow for care delivery outside of the office to reorganize care. Massachusetts General Hospital in Boston has adopted an IT system, TopCare, for population-based cancer screening in a large primary care network.

“Given current healthcare payment models, the limited resources available for novel population-based activities led us to examine how to optimize the effectiveness and efficiency of such IT systems using two methods derived from the field of operations research,” wrote lead author Adrian H. Zai, MD, of Massachusetts General Hospital, and colleagues.

The study’s authors utilized queuing theory and simulation analysis to investigate the impact of changes in staffing levels for patient outreach activities, modifications to user workflow within TopCare, and changes in cancer screening recommendations over a one year period.

Modeled as a queueing network, TopCare used “flow units” to represent the flow of each overdue cancer screening through a multiphase, multiserver queueing system. The queueing network model followed a next-event time-advance mechanism in simulation experiments. Systematic adjustments were made to staffing levels, IT workflow settings, and cancer screening frequency to determine their impact on overdue screenings per patient.

Results revealed that TopCare reduced the average number of overdue screenings per patient from 1.17 at its inception to 0.86 during simulation and 0.23 at steady state. Workforce increases improved the effectiveness of the IT system. Increasing the delegate staff level by one person improved screening completion rates by 1.3 percent, and 11 percent when one person was added to navigator staff level. Interestingly, changes in the amount of time a patient entry stayed on delegate and navigator lifts did not have a significant impact on overdue screenings.

By lengthening the screening interval, the efficiency of TopCare was increased by decreasing overdue screenings at patient level. As a result, a smaller number of overdue patients needed delegates for screening and a higher fraction of screenings was completed by delegates.

“With the growing volume of guidelines for different cancer screening modalities, ages, and screening frequencies, clinicians will be expected to make rapid and informed decisions about multiple (often conflicting) recommendations,” wrote Zai and colleagues. “Simulation analysis can accommodate and anticipate the impact of screening policy changes, thus providing clinical informatics leadership with a clear picture of the consequences of important decisions on preventive care at the institutional level given existing local resources.”

The study’s authors hope to conduct a complete cost-effectiveness analysis of the TopCare system in the future.