Bridging the Healthcare Access Divide: A Strategic Planning Model for Rural Telemedicine Network

Balancing access to healthcare and sustaining operational efficiency is a major issue in strategic planning of rural healthcare delivery systems. In this regard, telemedicine is being adopted as a versatile and low cost mechanism for delivering rural healthcare. This article presents a strategic planning model that incorporates different operational and service elements of the rural telemedicine healthcare network. Real-world data from the rural Black-belt region in the United States are used in a case study. A novel statistical approach based on decision trees and logistic regression is used to estimate demand of healthcare at the county level. Key issues such as the location of telemedicine health centers, coverage of health services, configuration of medical equipment, and patient travel policies are explored in light of patient demographics, scale of health coverage, and disease prevalence patterns. Results indicate that telemedicine networks can effectively improve healthcare services in rural areas with requisite operational efficiency

[1]  R. D'Agostino,et al.  External validity of predictive models: a comparison of logistic regression, classification trees, and neural networks. , 2003, Journal of clinical epidemiology.

[2]  Nicolette de Keizer,et al.  Integrating classification trees with local logistic regression in Intensive Care prognosis , 2003, Artif. Intell. Medicine.

[3]  Donald M Hilty,et al.  Rural versus suburban primary care needs, utilization, and satisfaction with telepsychiatric consultation. , 2007, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[4]  R K Grigsby,et al.  The Georgia State Telemedicine Program: initiation, design, and plans. , 1995, Telemedicine journal : the official journal of the American Telemedicine Association.

[5]  U. Strömberg,et al.  Prevalence odds ratio v prevalence ratio. , 1994, Occupational and environmental medicine.

[6]  M. Cermack,et al.  Monitoring and telemedicine support in remote environments and in human space flight. , 2006, British journal of anaesthesia.

[7]  Judy Williams,et al.  Realtime telemedicine for paediatric otolaryngology pre-admission screening , 2005, Journal of telemedicine and telecare.

[8]  B. Wakefield,et al.  Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. , 2008, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[9]  Vedat Verter,et al.  Location of Preventive Health Care Facilities , 2002, Ann. Oper. Res..

[10]  A. K. Shahani,et al.  Planning health services with explicit geographical considerations: a stochastic location-allocation approach , 2005 .

[11]  Armin Shmilovici,et al.  On the use of decision tree induction for discovery of interactions in a photolithographic process , 2003 .

[12]  Z. Agha,et al.  Cost effectiveness of telemedicine for the delivery of outpatient pulmonary care to a rural population. , 2002, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[13]  Katrina M. Krause,et al.  Is There Time for Management of Patients With Chronic Diseases in Primary Care? , 2005, The Annals of Family Medicine.

[14]  Christina R. Scherrer,et al.  Optimization of community health center locations and service offerings with statistical need estimation , 2008 .

[15]  Chris Myers,et al.  Forecasting demand and capacity requirements. , 2004, Healthcare financial management : journal of the Healthcare Financial Management Association.

[16]  Aaron B Caughey,et al.  Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. , 2007, The New England journal of medicine.

[17]  Kingshuk K. Sinha,et al.  Health Care Supply Chain Design: Toward Linking the Development and Delivery of Care Globally , 2009, Decis. Sci..

[18]  Kurt M. Bretthauer,et al.  Locating specialized service capacity in a multi-hospital network , 2011, Eur. J. Oper. Res..

[19]  G. Walsham,et al.  Social Structure and Managerial Agency in India , 1997 .

[20]  David L. Huff,et al.  Defining and Estimating a Trading Area , 1964 .

[21]  A. Bynum,et al.  The impact of telemedicine on patients' cost savings: some preliminary findings. , 2003, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[22]  A Allen,et al.  Patient satisfaction with telemedicine in a rural clinic. , 1994, American journal of public health.

[23]  S. Speedie,et al.  The relative cost of outpatient telemedicine services. , 1999, Telemedicine journal : the official journal of the American Telemedicine Association.

[24]  K. Flegal,et al.  Prevalence of overweight and obesity in the United States, 1999-2004. , 2006, JAMA.

[25]  Xin Wang,et al.  Optimization of preventive health care facility locations , 2010, International journal of health geographics.

[26]  Nir Menachemi,et al.  Factors Affecting the Adoption of Telemedicine—A Multiple Adopter Perspective , 2004, Journal of Medical Systems.

[27]  H. Hudson,et al.  Rural telemedicine: lessons from Alaska for developing regions. , 2005, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[28]  P. Mitropoulos,et al.  A biobjective model for the locational planning of hospitals and health centers , 2006, Health care management science.

[29]  John Lewis,et al.  Building participatory HIS networks: A case study from Kerala, India , 2009, Inf. Organ..

[30]  Brian E. Whitacre,et al.  Estimating the Economic Impact of Telemedicine in a Rural Community , 2011, Agricultural and Resource Economics Review.

[31]  Uday S. Karmarkar,et al.  Competitive Location on a Network , 1987, Oper. Res..

[32]  J. Grigsby,et al.  Rural applications of telemedicine. , 1997, Telemedicine journal : the official journal of the American Telemedicine Association.

[33]  Vedat Verter,et al.  Incorporating congestion in preventive healthcare facility network design , 2009, Eur. J. Oper. Res..

[34]  Karen Levesque,et al.  Telehealth provides effective pediatric surgery care to remote locations. , 2002, Journal of pediatric surgery.

[35]  Sally C. Brailsford,et al.  OR in healthcare: A European perspective , 2011, Eur. J. Oper. Res..

[36]  D Kriebel,et al.  Prevalence odds ratio or prevalence ratio in the analysis of cross sectional data: what is to be done? , 1998, Occupational and environmental medicine.

[37]  Jørn Braa,et al.  Networks of Action: Sustainable Health Information Systems Across Developing Countries , 2004, MIS Q..

[38]  Uzma Raja,et al.  Antecedents of open source software defects: A data mining approach to model formulation, validation and testing , 2009, Inf. Technol. Manag..

[39]  T. Young,et al.  Effectiveness of school-based telehealth care in urban and rural elementary schools. , 2003, Pediatrics.

[40]  C. Avgerou,et al.  Introducing the Special Issue on Information and Communication Technologies in Developing Countries , 2002 .

[41]  T. Nesbitt,et al.  Perceptions of local health care quality in 7 rural communities with telemedicine. , 2005, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[42]  T C Ricketts Health care in rural communities. , 2000, The Western journal of medicine.

[43]  Sundeep Sahay,et al.  The role of communication practices in the strengthening of counter networks: Case experiences from the health care sector of Mozambique , 2005 .

[44]  Megan E. Piper,et al.  Using Decision Tree Analysis to Identify Risk Factors for Relapse to Smoking , 2011, Substance use & misuse.

[45]  Carl May,et al.  Remote Doctors and Absent Patients: Acting at a Distance in Telemedicine? , 2003 .

[46]  Abdur Rais,et al.  Operations Research in Healthcare: a survey , 2011, Int. Trans. Oper. Res..

[47]  R. Bender,et al.  Ordinal Logistic Regression in Medical Research , 1997, Journal of the Royal College of Physicians of London.

[48]  Yoon Sang Kim Telemedicine in the USA with focus on clinical applications and issues. , 2004, Yonsei medical journal.

[49]  Pamela Whitten,et al.  Private payer reimbursement for telemedicine services in the United States. , 2007, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[50]  Kurt M. Bretthauer,et al.  A Model for Planning Resource Requirements in Health Care Organizations , 1998 .

[51]  Lars E Peterson,et al.  Associations Between Self‐reported Quality of Care and County Characteristics Are Largely Similar in Rural and Urban Settings , 2009, Quality management in health care.

[52]  Sydney C. K. Chu,et al.  A modeling framework for hospital location and service allocation , 2000 .

[53]  Vladimir Marianov,et al.  Optimal location of public health centres which provide free and paid services , 2001, J. Oper. Res. Soc..

[54]  Jonathan Matusitz,et al.  An Evolutionary Examination of Telemedicine: A Health and Computer-Mediated Communication Perspective , 2010, Social work in public health.

[55]  Christian Stummer,et al.  Determining Location and Size of Medical Departments in a Hospital Network: A Multiobjective Decision Support Approach , 2004, Health care management science.