Maximizing Intervention Effectiveness
59 Pages Posted: 29 Aug 2017 Last revised: 13 Sep 2019
Date Written: August 26, 2017
Frequently, policymakers seek to roll out an intervention previously proven effective in a research study, perhaps subject to resource constraints. However, since different subpopulations may respond differently to the same treatment, there is no a priori guarantee that the intervention will be as effective in the targeted population as it was in the study. How then should policymakers target individuals to maximize intervention effectiveness? We propose a novel robust optimization approach that leverages evidence typically available in a published study. Our approach is tractable -- real-world instances are easily optimized in minutes with off-the-shelf software -- and flexible enough to accommodate a variety of resource and fairness constraints. We compare our approach with current practice by proving tight, performance guarantees for both approaches which emphasize their structural differences. We also prove an intuitive interpretation of our model in terms of regularization, penalizing differences in the demographic distribution between targeted individuals and the study population. Although the precise penalty depends on the choice of uncertainty set, we show for special cases that we can recover classical penalties from the covariate matching literature on causal inference. Finally, using real data from a large teaching hospital, we compare our approach to current practice in the particular context of reducing emergency department utilization by Medicaid patients through case management. We find that our approach can offer significant benefits over current practice, particularly when the heterogeneity in patient response to the treatment is large.
Keywords: analytics, robust optimization, intervention effectiveness, healthcare
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