DEVELOPING AN OPTIMAL MODEL FOR INFANT HOME VISITATION

The United States, Great Britain, Denmark, Canada and many other countries have accepted home visitation (HV) as a promising strategy for interventions for infants after births and for their mothers. Prior HV studies have focused on theoretical foundations, evaluations of programs, cost/benefit analysis and cost estimation by using hospital/payer/insurance data to prove its effectiveness and high cost. As governments and private organizations continue to fund HVs, it is an opportune time to develop and formulate operations research (OR) models of HV coverage, quality and cost so they might be used in program implementation as done for adult home healthcare (HHC) and home care (HC). This dissertation introduces a new modeling approach and proposes a solution methodology which helps to determine the schedules of follow-up nursing care providers (NCP) to visit discharged patients in order to minimize total follow-up cost at the planning and operational level, and to improve the quality of care. The model improves the quality of treatment of infants and mothers during pregnancy, after birth and discharge from the hospital by maximizing the quality of assignment of the right NCP with the right skill, nurse type and years of experience to the right patient with the specific health need. The modeling approach is based on a mixed-interger programming (MIP) formulation that represents the dynamics of the system comprising aspects such as visit schedules and total program’s cost while satisfying a variety of requirements modeled as constraints. The model is tested and validated with real life data. Computational results for the formulation for real life instances of the problem with the Nurse Family Partnership Program (NFP) obtained using IBM CPLEX optimization Studio version 12.6.1 are presented. The intent is to enhance the administrative and deployment process of HV programs, minimize risks, allow planners to explore the best scenarios under different conditions related to cost, treatment and coverage requirements, and highlight the best course of action when assigning NCPs to clients. Results show significant cost savings and enhanced quality treatment in several cases studied and tested. Finally, the study identifies and presents fertile avenues for future research for this field.