Informs Annual Meeting 2017

TA09

INFORMS Houston – 2017

TA07

Health Belief Model to explain the dynamics of primary care access that captures the different stages of getting qualified, enrolling in Medicaid, seeking primary care services, and utilizing preventative care. Finally, the results of simulation model were applied to create a dynamic GIS map which shows the growth of Medicaid enrollees throughout the County, and the distance of patients to primary care providers will be investigated. 2 - Analyzing Optimal Screening Policies for Post-traumatic Stress Disorder in the Presence of Social Stigma Mohammad S. Jalali, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, United States, jalali@mit.edu, Navid Ghaffarzadegan, Richard C. Larson Post-traumatic stress disorder (PTSD) stands out as a major mental illness and screening policies have played a critical role in mitigating the effects of PTSD. However, little agreement exists on the optimal cutoff value—a threshold above which screening scores should be considered as PTSD positive. We develop a simulation model of PTSD screening which includes social forces that inhibit accurate screening. Our analysis shows that with the presence of public stigma, current dichotomous screening policies are not effective to minimize the number of false positive and false negative. 3 - Combination of System Dynamics Modeling and Social Marketing for Increasing Colorectal Cancer Screening Brian Biroscak, PhD, MS, MA, Yale School of Medicine, New Haven, CT, 06519, United States, brian.biroscak@yale.edu, Peter Hovmand Human learning in and about complex systems is a feedback process. Yet in the world of social action, feedback processes often do not operate well. We will present our experience using a social marketing approach as one potential means for overcoming the implementation challenge in system dynamics modeling, within the context of an initiative to increase colorectal cancer (CRC) screening. We applied a modeling approach called ‘community based system dynamics’. The primary purpose of the model (Stella ArchitectTM; Stella OnlineTM) is to help this academic-community partnership design a social marketing strategy for implementing evidence-based interventions that will increase CRC screening. 4 - Towards Optimal Antibiotic Prescribing for Acute Respiratory Tract Infections in Ambulatory Settings by Applying System Dynamics Modeling Hamed Kianmehr, State Univerity of New York, Binghamton, NY, 13905, United States, hkianme1@binghamton.edu, Nasim S. Sabounchi, Leon E. Cosler, KarenBeth H. Bohan Antibiotic resistance is a growing public health concern. There are several conditions for which antibiotics are prescribed excessively including acute respiratory tract infections (ARTIs). The goal of this study is to find key factors that lead to excessive antibiotic prescriptions among ARTI patients. We developed a system dynamics model to reproduce antibiotic prescriptions for ARTI, from the National Ambulatory Medical Care Survey (NAMCS), 1993-2014. The best-fit model captures the relationship between patient and physician decision making properly. The simulation results indicate that patient expectation has a strong effect on physician intention for prescribing antibiotics.

322A New Scheduling and Capacity Management Approaches to Improve Patient Access to Medical Services Sponsored: Health Applications Sponsored Session Chair: Mustafa Y Sir, Mayo Clinic, Rochester, MN, 55905, United States, sir.mustafa@mayo.edu 1 - Acuity Based Demand Management Bjorn Berg, Mayo Clinic, KPSL 21, 200 First Street SW, Rochester, MN, 55905, United States, berg.bjorn@mayo.edu, Brian Klute, Tarun Mohan Lal Outpatient specialty practices, notably at large medical centers, face a matrix of uncertainties and objectives when making planning and operational decisions. Uncertainties include requests for new appointments, the mix of services required, and patient preferences. The effects of these uncertainties need to be managed to pursue criteria such as ensuring that the right patients are provided care based on their acuity and needs, the time patients must wait for an appointment, and utilization rates of provider calendars. We present a series of predictive analyses, capacity management models, and simulation-based approaches used to manage demand at an outpatient quaternary care practice. 2 - Online Surgery Reservation to Optimize Surgical Day Utilization Maria Martinez, Mayo Clinic, Rochester, MN, United States, Martinez.Maria@mayo.edu, Alexander Mafusalov, Mustafa Y. Sir, Kalyan Pasupathy This paper proposes a novel surgical scheduling optimization method within the general framework of a resource allocation problem. In the clinical setting, a patient enters the department with a diagnosis, which, after a clinical consultation, is linked to a specific surgical procedure. Surgery time slot is reserved upon arrival, when the procedure information is not available. The paper studies the long-run allocation policies, based on the demand in diagnoses, the stochastic relationship linking a diagnosis to a procedure, and on the surgical capacity. The objective is to minimize the surgeons’ overtime hours. Numerical experiments on real data illustrate the effectiveness of the methods. 3 - Improving Patient Access of Back Pain Patients Derya Kilinc, Arizona State University, 1975 E University Dr, Apt 162, Tempe, AZ, 85281, United States, dkilinc@asu.edu, Esma S.Gel, Bernard Bendok Back pain is one of the leading health problems that affect a significant portion of the population. Identifying the patients that needs a surgical intervention and improving the access of those patients to right providers are crucial in healthcare delivery. We present our results on improving patient access based on of our year- long study in a neurosurgery clinic. Our results suggest that by prioritizing the patients need surgery and managing the capacity, we can achieve improvements in patient access. 4 - A Decision-support Tool for Capacity Management of Two-step Service Calendar Phichet Wutthisirisart, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, Wutthisirisart.Phichet@mayo.edu, Maria Gabriela Martinez, Kalyan Pasupathy, Mustafa Y. Sir This works assess the performance of clinical and surgical calendars in an elective surgical practice. A simulation-based approach is proposed to score the efficiency of calendar with respect to the length of the planning horizon. Our approach generates key performance metrics to assists the identification of potential inefficiencies in the calendar.

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330A Structural Modeling and Estimation in Operations Management Sponsored: Manufacturing & Service Oper Mgmt Sponsored Session

Chair: Jun Li, Ross School of Business, University of Michigan, Ann Arbor, MI, 48109, United States, junwli@umich.edu Co-Chair: Yixin Wang, University of Michigan, Ann Arbor, MI, 48104, United States, iriswang@umich.edu 1 - Manufacturing and Regulatory Barriers to Generic Drug Competition: A Structural Model Approach Yixin Wang, University of Michigan, 701 Tappan Street R4323, Ross School of Business, Ann Arbor, MI, 48104, United States, iriswang@umich.edu, Jun Li, Ravi Anupindi Understanding the drivers of market concentration in the generic pharmaceutical industry is essential to guarantee the accessibility of low-cost generics. In this paper, we develop a structural model to capture the determinants of manufacturers’ entry decisions and estimate the model using data collated from six disparate sources. In particular, this study focuses on the impact of production cost and regulatory barrier. We find that production complexity, as reflected for example in the administration route, significantly reduces the likelihood of generic entries. An increase in the processing time of production applications due to government capacity issue also deters firms from entering.

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322B System Dynamics in Healthcare Sponsored: Health Applications Sponsored Session

Chair: Nasim Sabounchi, State University of New York at Binghamton, Systems Science and Industrial Engineering, Binghamton, NY, 13902, United States, sabounchi@binghamton.edu 1 - Medicaid Access to Primary Care in Broome County, NY – A Combination of GIS and System Dynamics Methodology Nasim S. Sabounchi, State University of New York at Binghamton, 4400 Vestal Parkway East, P.O. Box 6000, Systems Science and Industrial Engineering, Binghamton, NY, 13902, United States, sabounchi@binghamton.edu, Nasser Sharareh, Serdar Atav The effect of Medicaid expansion on primary care access is studied from the spatial aspect. We built a system dynamics model using the constructs of the

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