Operational research applied to decisions in home health care: A systematic literature review

The efficient deployment of resources in home-based care is considered crucial for the sustainability of health and social care systems worldwide. The aim of this study was to identify and review operational research approaches to support decision-making in home health care. We identified a set of linked decisions at different planning levels (strategic, tactical, operational) and conducted a systematic review of operational research approaches used to address these decisions. We also sampled OR literature applied to analogous decisions in other settings. The 77 papers selected focused predominantly on solutions for staff-to-patient allocation, visit scheduling and staff routing, few of which were adopted by organisations. Few studies dealt with tactical decisions of team size and composition or strategic decisions of districting, and we found no studies on contract design for commissioning home health care, on staff role definitions or on reassessment of patient need. Integrative work is scarce and the aspects of system performance considered are variable and diverse. For these reasons the literature does not provide guidance for home health care services aspiring to effective and coherent decisions across planning levels. OR approaches from other areas of application provide some insights for future research aimed at addressing this shortfall.居家护理场景下的资源高效配置，被视为全球卫生与社会照护体系可持续发展的核心要务。本研究旨在识别并梳理支撑居家健康照护决策的运筹学（Operational Research）方法。我们明确了不同规划层级（战略层、战术层、执行层）下的一系列关联决策，并针对用于解决这些决策问题的运筹学方法开展了系统性综述；同时还选取了应用于其他场景下同类决策问题的运筹学文献进行分析。 本次筛选纳入的77篇文献，其研究重点主要集中于医护人员-患者分配、出诊调度与医护人员路线规划三类解决方案，但鲜有方案被相关机构采纳。极少有研究涉及团队规模与构成的战术层决策，以及区划划分的战略层决策；且未发现任何关于居家健康照护委托合同设计、医护人员角色定义，或是患者需求再评估的相关研究。 整合性研究较为匮乏，且现有研究对系统绩效的考量维度繁杂多样。基于上述原因，现有文献无法为居家健康照护服务机构提供跨规划层级制定高效且连贯决策的指导依据。 来自其他应用领域的运筹学方法，可为弥补这一研究缺口的后续研究提供部分借鉴思路。