Planning for HIV Screening, Testing and Care at the Veterans Health Administration

54 Pages Posted: 27 Sep 2013 Last revised: 28 Aug 2014

See all articles by Sarang Deo

Sarang Deo

Indian School of Business (ISB), Hyderabad - Operations Management

Kumar Rajaram

University of California, Los Angeles - Anderson School of Business

Sandeep Rath

University of North Carolina (UNC) at Chapel Hill - Kenan-Flagler Business School

Uday S. Karmarkar

University of California, Los Angeles (UCLA) - Anderson School of Management

Matthew Goetz

United States Government - Department of Veterans Affairs (VA)

Date Written: August 20, 2014

Abstract

We analyzed the planning problem for HIV screening, testing and care. This problem consists of determining the optimal fraction of patients to be screened in every period as well as the optimum staffing level at each part of the health care system to maximize the total health benefits to the patients measured by Quality-Adjusted Life-Years (QALYs) gained.We modeled this problem as a nonlinear mixed integer programming program comprising of disease progression (the transition of the patients across health states), system dynamics (the flow of patients in different health states across various parts of the health care delivery system), budgetary and capacity constraints.We applied the model to the Greater Los Angeles (GLA) station in the Veterans Health Administration (VHA) system. We found that a Center for Disease Control recommended routine screening policy in which all patients visiting the system are screened for HIV irrespective of risk factors may not be feasible due to budgetary constraints. Consequently, we used the model to develop and evaluate managerially relevant policies within existent capacity and budgetary constraints to improve upon the current risk based screening policy of screening only high risk patients. Our computational analysis showed that the GLA station can achieve substantial increase (20% to 300%) in the QALYs gained by using these policies over risk based screening.The GLA station has already adapted two of these policies that could yield better patient health outcomes over the next few years. In addition, our model insights have influenced the decision making process at this station.

Keywords: Routine HIV screening, budget constraint, healthcare operations

Suggested Citation

Deo, Sarang and Rajaram, Kumar and Rath, Sandeep and Karmarkar, Uday S. and Goetz, Matthew, Planning for HIV Screening, Testing and Care at the Veterans Health Administration (August 20, 2014). Available at SSRN: https://ssrn.com/abstract=2331107 or http://dx.doi.org/10.2139/ssrn.2331107

Sarang Deo (Contact Author)

Indian School of Business (ISB), Hyderabad - Operations Management ( email )

India

HOME PAGE: http://www.isb.edu/faculty-research/faculty/directory/deo-sarang

Kumar Rajaram

University of California, Los Angeles - Anderson School of Business ( email )

110 Westwood Plaza
Los Angeles, CA 90095-1481
United States

Sandeep Rath

University of North Carolina (UNC) at Chapel Hill - Kenan-Flagler Business School ( email )

McColl Building
Chapel Hill, NC 27599-3490
United States

Uday S. Karmarkar

University of California, Los Angeles (UCLA) - Anderson School of Management ( email )

110 Westwood Plaza
Los Angeles, CA 90095-1481
United States

Matthew Goetz

United States Government - Department of Veterans Affairs (VA) ( email )

810 Vermont Avenue NW
Washington, DC 20420
United States

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