title: Responding to traveling patients' seasonal demand for health care services.
abstract: The Veterans Health Administration (VHA) provides care to over 8 million Veterans and operates over 1,700 sites of care across 21 regional networks in the United States. Health care providers within VHA report large seasonal variation in the demand for services, especially in the southern United States because of arrival of "snowbirds" during the winter. Because resource allocation activities are primarily carried out through an annual budgeting process, the seasonal load imposed by "traveling Veterans"-Veterans that seek care at VHA sites outside of their home network-make providing high-quality services more challenging. This work constitutes the first major effort within VHA to understand the impact of traveling Veterans. We discovered strong seasonal fluctuations in demand at a clinic located in the southeastern United States and developed a seasonal autoregressive integrated moving average model to help the clinic forecast demand for its services with significantly less error than historical averaging. Monte Carlo simulation of the clinic revealed that physicians are overutilized, suggesting the need to re-evaluate how the clinic is currently staffed. More broadly, this study demonstrates how operations management methods can assist operational decision making at other clinics and medical centers both within and outside VHA.
authors.affiliation: Engineering Systems Division, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Building E38, Cambridge, MA 02139.
authors.forename: Shahed
authors.initials: S
authors.lastname: Al-Haque
authors.affiliation: Engineering Systems Division, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Building E38, Cambridge, MA 02139.
authors.forename: Mehmet Erkan
authors.initials: ME
authors.lastname: Ceyhan
authors.affiliation: New England Veterans Engineering Resource Center, 150 South Huntington Avenue, Building 9, Boston, MA 02130.
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Chan
authors.affiliation: Engineering Systems Division, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Building E38, Cambridge, MA 02139.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Nightingale
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data* / Q000600:supply & distribution; D003198:Computer Simulation; D005544:Forecasting / Q000379:methods; D006295:Health Resources / Q000706:statistics & numerical data* / Q000600:supply & distribution; D006301:Health Services Needs and Demand / Q000639:trends*; D063426:Human Migration / Q000639:trends; D006801:Humans; D015233:Models, Statistical; D009010:Monte Carlo Method; D012621:Seasons; D015144:Southeastern United States; D014195:Travel / Q000639:trends; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014728:Veterans; D000078329:Workforce