Healthcare Systems - Группа авторов

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      Chapter written by Cléa MARTINEZ, Maria DI MASCOLO, Marie-Laure ESPINOUSE and Jérôme RADUREAU.

      2

      Home Healthcare Scheduling Activities

      2.1. Introduction

      Home healthcare (HHC) is a field of research which, due to its complexity in terms of organization and diversity of players, not to mention in the medical and social specificities of patients, opens up several fields of investigation. We can identify the optimization challenges inherent to the management of the HHC structure, which in turn leads to significant research activity on problems concerning nurse rostering and drug deliveries. The optimization problem in HHC must take into account several constraints related to the organization of the structure, the patient, road traffic, emergencies, etc. The purpose is to ensure visits to patients according to their care plans. One of the major constraints in the organization of care is taking into account emergencies as well as uncertainties such as changes in the duration of care and also the disturbances caused by the external environment (road traffic, for example).

      In this chapter, we present a solution for the HHC planning problem by integrating uncertainties and dynamic rescheduling. We first present a literature review with recent works that have focused on HHC planning. Section 2.3 focus on the proposed approach, which is based on a genetic algorithm with the consideration of real-time disturbances and uncertainties. Section 2.4 presents the experiments and the obtained results. We finish this chapter with a conclusion and some perspectives.

      The increase of the number of elderly people in France has led to a substantial increase in the demand for HHC services (e.g. home support structures, home hospitalization, etc.). This demand is due to two main causes:

       – home care is less expensive for health insurance companies and helps to relieve congestion in hospitals;

       – people who are still autonomous want to stay at home and benefit from HHC services (cleaning, reading, meal delivery, etc.).

      HHC structures play an important role in the development of the silver economy and offer better well-being for elderly people. However, the organization of HHC is complex and difficult to control due to the multiplicity and diversity of players, their status (private or public), as well as their function (medical, paramedical, social, administrative). Moreover, each treatment is specific and must be personalized insofar as it relies on the patient’s level of dependency.

      HHC services require coordinated organization between all the stakeholders involved in the patient care plan. This coordination must take into account organizational and geographical constraints, working hours and constraints related to the patients (availability, preferences, activities of daily living, etc.).

      Several constraints must be taken into account in HHC scheduling problems (Fikar and Hirsch 2017). Three classes of constraints have been identified: time constraints, assignment constraints and geographic constraints. The first class concerns the constraints associated with temporal relationships, that is, at what time the HHC service can take place or the time at which a caregiver can provide a service according to their schedule. Assignment constraints are linked to the relationships

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