Stratified Patient Appointment Scheduling for Community-based Chronic Disease Management Programs

TL;DR

This paper explores how incorporating patient time-of-day preferences into appointment scheduling improves adherence and health outcomes in community-based chronic disease management, especially for asthma programs.

Contribution

It demonstrates the benefits of patient stratification and preference incorporation in appointment scheduling, highlighting simple policies that perform well compared to complex optimization methods.

Findings

Patient stratification improves appointment adherence and health outcomes.

Incorporating time preferences leads to substantial community health benefits.

Simple scheduling policies can match the performance of optimization-based approaches.

Abstract

Disease management programs have emerged as a cost-effective approach to treat chronic diseases. Appointment adherence is critical to the success of such programs; missed appointment are costly, resulting in reduced resource utilization and worsening of patients' health states. The time of an appointment is one of the factors that impacts adherence. We investigate the benefits, in terms of improved adherence, of incorporating patients' time-of-day preferences during appointment schedule creation and, thus, ultimately, on population health outcomes. Through an extensive computational study, we demonstrate, more generally, the usefulness of patient stratification in appointment scheduling in the environment that motivates our research, an asthma management program offered in Chicago. We find that capturing patient characteristics in appointment scheduling, especially their time preferences, leads to substantial improvements in community health outcomes. We also identify settings in which simple, easy-to-use policies can produce schedules that are comparable in quality to those obtained with an optimization-based approach.