Tema: Development of a decision support system for home health care management: the Portuguese and Brazilian cases

Autor: William Machado Emiliano

Programa Doutoral em Engenharia Industrial e de Sistemas

Data: 11/09/2020

Orientadores: José Telhada; Maria do Sameiro Carvalho

Abstract: Home health services or Home Health Care (HHC), are a complement or alternative to traditional inpatient health care services in health centers and hospitals. In developed countries, with increasing rates of aging of their populations, this type of service has taken on complexity and relevance in the context of health services.

These HHC are usually based on a network of providing health services to users in their homes. This medical care is provided by multidisciplinary teams that are organized to ensure a quality service. There are several logistical problems that these services face in the planning and operationalization of their care activity. However, literature in the area is scarce, particularly in solving problems of a more strategic nature, such as the organization of the territory in districts to be assigned to the different teams. Additionally, no studies were found in the literature that characterize and compare these approaches in different countries.

This research project intends to make a comparative study of HHC services between Portugal and Brazil, in the approaches to different logistical problems. The second objective focused on the development of a decision support system (DSS) capable of solving districting problems for HHC teams. Comparative analysis of the two HHC systems allows us to identify the main differences between the two systems and the best practices that could be adopted. The development of a new DSS allows exploring and testing approaches that support the resolution of one of the strategic problems that is critical to the success of this type of care activity: the definition of districting. This DSS incorporates a multi-objective district definition model and a route simulation module that allows you to estimate the logistics costs that result from this districting plan. The multi-objective model combines three different dimensions: service efficiency, team workload balancing and districts contiguity and compactness. The model, solved with the augmented weighted Tchebycheff method, was tested on a small instance based on a real case. Additionally, DSS applications were made to a set of cases, both in Portugal and in Brazil.

The result obtained through this comparison showed that in both countries there is a need for HHC improvements, mainly because most of their logistical problems are still empirically solved, it was also possible to detect best practice in managing the problems of each country. The use of DSS and its methodological approach is applicable to different real contexts. In particular, the results show that it will be possible to achieve operational gains associated with the solutions produced, such as reducing operating costs by 14% for Portuguese teams, and about 2% for Brazilian teams. The districting plans with the largest savings were those of ACES Cávado I (Portugal) and Curitiba (Brazil), representing together about 58% of the total savings obtained in both countries. This was due to the high rates of workload deviation in the current districting plans of both cases.

Palavras-Chave: Home Health Care; Augmented Weighted Tchebycheff Method; Multi-objective model; Logistic Planning; Districting.