title: 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.
  
  
  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.
authors.affiliation: Laboratory of Computer Science, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Zai
authors.forename: Seokjin
authors.initials: S
authors.lastname: Kim
authors.forename: Arnold
authors.initials: A
authors.lastname: Kamis
authors.forename: Ken
authors.initials: K
authors.lastname: Hung
authors.forename: Jeremiah G
authors.initials: JG
authors.lastname: Ronquillo
authors.forename: Henry C
authors.initials: HC
authors.lastname: Chueh
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
mesh_terms: D003198:Computer Simulation; D055088:Early Detection of Cancer; D006293:Health Promotion; D006801:Humans; D008962:Models, Theoretical; D009874:Operations Research; D010346:Patient Care Management / Q000458:organization & administration*; D057188:Workflow
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
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