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.