Research On Collaborative Home Health Care Scheduling Problem By Considering Door-to-door And Outpatient Services

With the decline of fertility rate and the extension of life expectancy,the aging problem is getting worse,and people’s demand for medical and health service resources is increasing.To improve the community pension system and meet the demands of most patients for longterm and continuous health care services in China,family doctor contract services are developed by the government at the grassroots level.These services combine home health care services with outpatient services,which can serve a wide range of patients,and are conducive to the long-term health supervision of the “key population” such as the elderly,patients with chronic diseases.It has become an important way to safeguard people’s health in China.In family doctor contract services,doctors not only provide door-to-door services at patients’ homes(mainly for the elderly or patients with mobility difficulties),but also provide outpatient services for patients who need general medical treatment or large medical equipment at the community care center.These new services with two service modes can allocate medical resources more flexibly,but also pose a problem for the optimal management of medical personnel scheduling.Meanwhile,the existing scheduling researches considering only a single service mode is not suitable for this background.To better meet the patients’ needs and reduce the operating costs,four home health care routing and scheduling problems with different service mode assignments of doctors,patient demand characteristics and scheduling periods are studied in this thesis.First,based on the service mode of family doctor contract services,we introduce and model a new daily home health care routing and scheduling problem with the consideration of outpatient services.According to patients’ requirements,this problem aims to determine the service mode for each doctor,the doctor-patient matching in outpatient services,and the routes for doctors in door-to-door services.Considering the constraints about skill requirements,time windows,and working regulations,a mixed-integer nonlinear model is established.The model aims at minimizing the total travel costs of the door-to-door services and the total waiting time of outpatients,and maximizing the patients’ preference satisfaction.Combining with the problem characteristics,we use an outer-approximation method to obtain its global (?)-optimal solutions for the small problem and develop a hybrid genetic algorithm to solve the large problem.The numerical experiment results imply that: The scheduling schemes of the two service modes influence each other,the resultant scheme focuses more on optimizing the service scheduling with higher weight;Compared with home health care services of only doorto-door services,the combination of door-to-door and outpatient services can serve more patients with lower operating costs;Strictly limiting the conditions for patients to reserve doorto-door services,so as to reduce the number of patients in need of door-to-door services,can effectively reduce the operating costs.Second,to improve the utilization rate of medical resources and balance the workload of door-to-door and outpatient doctors,we introduce and model a daily routing and scheduling problem in dual service mode with the consideration of the transformation of doctors’ service mode.By introducing a time node for service mode transformation,this problem allows the doctors who have finished the door-to-door services to continue to provide outpatient services.According to patients’ requirements,this problem aims to determine the changements of service mode for each doctor,the routes of doctors in door-to-door services,and the doctorpatient matching in outpatient services.This problem is also formulated as a mixed-integer nonlinear model to minimize the travel costs of the door-to-door services and the total waiting time of outpatients,and maximize the patients’ preference satisfaction.Combining with the problem characteristics,we use an outer-approximation method to obtain its global (?)-optimal solutions for the small problem and develop a hybrid genetic algorithm to solve the large problem.The numerical experiment results imply that: Compared with the schedule scheme of problem 1,the scheduling scheme of this problem can reduce the workload of doctors serving outpatients,and reduce the waiting time of outpatients and total costs by setting appropriate time node for service mode transformation;With the increase of the weight of outpatient services,doctors with higher service rate and higher skill levels will be arranged in outpatient services and door-to-door transformed outpatient services,and the waiting time of outpatients will decrease.Third,during the service processes that obtained by the problem 1,some unexpected cases may occur,such as canceling or adding some new demands of patients,etc.We introduce and model a daily routing and scheduling problem in dual service mode with the consideration of patients’ dynamic demands.By introducing the time axis,this problem is divided into three parts: optimization of initial scheduling scheme,dynamic optimization of door-to-door services routes and optimization of outpatient scheduling in overtime.All the optimization processes are aimed at minimizing the travel costs of the door-to-door services and the total waiting time of outpatients,and maximizing the patients’ preference satisfaction.Combining with the characteristics of the problem,we develop a three-stage algorithm based on rolling horizon to solve this problem.Numerical experiments results imply that: Compared with the periodic routing update strategy,adopting the event triggered routing update strategy can ensures more patients be served,appropriately reduces the travel costs and improves the door-to-door patients’ preference satisfaction,it is more suitable for this problem;Allowing doctors who have completed the door-to-door services to provide outpatient services at the beginning of overtime can reduce the waiting time of outpatients and increase their preference satisfaction.Finally,extending the planning horizon of problem 1 to multiple days,we introduce and model a multi-period home health care routing and scheduling problem with the consideration of outpatient services.Assuming the patients’ service frequencies are fixed in the planning horizon,this problem needs to determine the the service days for each patient,service mode for each doctor,the doctor-patient matching for the outpatient services,and the routes of doctors arranged for the door-to-door services on each day.Considering the constraints about skill requirements,time windows,and working regulations,a mixed-integer nonlinear model is established.The model aims at minimizing the total travel costs of the door-to-door services and the total waiting time of outpatients,and maximizing the service continuity and patients’ preference satisfaction for time windows that received service.Combining with the problem characteristics,we use an outer-approximation method to obtain its global (?)-optimal solutions for the small problem,and develop a hybrid tabu search algorithm for the large problem.The numerical experiment results imply that: The scheduling schemes of the two service modes influence each other;With the change of the maximum skill deviation of doctors,the patients’ service dates and the schedules of doctors on each day change.This thesis studies four difffernet home health care routing and scheduling problems under the dual service mode of door-to-door and outpatient services.The research conclusion has practical guiding significance for the scheduling decision of doctors in family doctor contract service.Under the medical resources in short situation,this thesis can to some extent promote the development and improvement of family doctor contract service.