Abstract Long travel distances and a lack of healthcare facilities provide significant challenges for healthcare in rural areas. Telehealth (online) platforms provide new care options, and omnichannel, or multichannel, healthcare supply chains provide healthcare consumers with choices such as traveling to a hospital or clinic, using telehealth from home, or using conveniently located telehealth kiosks. This research investigates design of a network of telehealth kiosks that can reduce the rural resident travel distance and time, and thereby improve rural healthcare access. Our focus is on optimally designing such a network, including determining the number and locations of kiosks. We use data-driven analytical modeling to assess coverage, travel distance and time, and costs for rural residents to reach a kiosk or other healthcare facility. We consider options with both unstaffed kiosks that provide teleconsultation, as well as kiosks that have scheduled periodic staffing from health professionals (e.g., once every two weeks, or once a month). We also consider an option to use drones (UAVs) to deliver supplies and medications to telehealth kiosks, thereby providing near-immediate availability of a wide range of medical supplies and medicines. The research first develops strategic analytical models using continuous approximation methods to assess the optimal number of telehealth kiosks to deploy and their dependence on the key costs and healthcare coverage. We then develop tactical discrete mixed integer linear programming (MILP) models for designing a telehealth kiosk network and apply the models using data for a rural region of Missouri.
Description "Part 1: Literature review:
(i) identify the present and near-term state-of-the-art for telehealth kiosk use,
(ii) identify relevant cost and operational parameters for telehealth kiosks,
(iii) develop estimates of (or tools for estimating) demand for telehealth kiosks, including correlations between demands for kiosks, and demands at other healthcare facilities such as clinics and hospitals
(iv) identify barriers to implementing telehealth kiosks in rural areas of the USA.
Part 2: Strategic continuous approximation modeling and analysis.
(i) formulate continuous approximation models of total system costs for all options,
(ii) solve models for base case parameter values and identify how performance depends on key problem parameters,
(iii) conduct sensitivity analyses of the impact of changing key parameters (e.g., demand density, coverage range limit, drone costs),
(iv) analysis of results, and specification of optimal system designs,
(v) write up results
3. Discrete MILP modeling and analysis
(i) formulate MILP models of total system costs for all options,
(ii) solve models for base case parameter values,
(iii) sensitivity analyses of the impact of changing key parameters (e.g., demand level, coverage range limit, drone costs),
(iv) analysis of results and case study in southeast Missouri, and
(v) write up results."
Objective There are three main work products. The literature review will produce a report that is the foundation for understating networks of telehealth kiosks and provides future research directions. This part of the project also provides the background and literature review sections for the journal publications, and generates data to be used in the models. Each of the modeling parts of the project will produce a journal article with one on strategic continuous approximation modeling to optimize a network of telehealth kiosks, and the other on discrete optimization modeling of a network of telehealth kiosks, including a case study in rural Missouri.
Impacts/Benefits "Outcomes and Desired Impacts: The intended outcome is to make the system more equitable by providing safe and affordable healthcare transport options. The desired impact will be on the disadvantaged population of Region 7.
Improving healthcare in rural areas (including Missouri)
Providing strategic and tactical guidance for the deployment of telehealth kiosks to improve healthcare efficiency and equity"