Christina R. Scherrer

Optimization of Community Health Center Locations and Service Offerings with Statistical Need Estimation

Community Health Centers (CHCs) provide family-oriented healthcare services for people living in rural and urban medically underserved communities; they are an important part of the governments plan to make healthcare more affordable. An optimization model is developed to determine the best location and number of new CHCs in a geographical network, as well as what services each CHC should offer at which capacity level. The weighted demand coverage of the needy population is maximized subject to budget and capacity constraints, where costs are fixed and variable. Statistical methods are applied to national health databases to determine important predictors of healthcare need and disease weights, and these methods are applied to census data to obtain county-based estimates of demand. Using several performance metrics such as the number of encounters, service of uninsured persons, and coverage of rural counties, the results of the system approach to location are analyzed using the state of Georgia as a prototype. It is demonstrated that optimizing the overall network can result in improvements of 20% in several measures. The proposed model is used to analyze policy questions such as how to serve the uninsured.

The Stop-And-Drop Problem in Nonprofit Food Distribution Networks

In this paper, we introduce the stop-and-drop problem (SDRP), a new variant of location-routing problems, that is mostly applicable to nonprofit food distribution networks. In these distribution problems, there is a central warehouse that contains food items to be delivered to agencies serving the people in need. The food is delivered by trucks to multiple sites in the service area and partner agencies travel to these sites to pick up their food. The tactical decision problem in this setting involves how to jointly select a set of delivery sites, assign agencies to these sites, and schedule routes for the delivery vehicles. The problem is modeled as an integrated mixed-integer program for which we delineate a two-phase sequential solution approach. We also propose two Benders decomposition-based solution procedures, namely a linear programming relaxation based Benders implementation and a logic-based Benders decomposition heuristic. We show through a set of realistic problem instances that given a fixed time limit, these decomposition based methods perform better than both the standard branch-and-bound solution and the two-phase approach. The general problem and the realistic instances used in the computational study are motivated by interactions with food banks in southeastern United States.

Comparison of an Introductory Level Undergraduate Statistics Course Taught with Traditional, Hybrid, and Online Delivery Methods

In light of the lack of consensus on the effectiveness of online education, there continues to be a need for more quantitative studies comparing hybrid, online, and traditional delivery methods. This paper compares and contrasts the three delivery methods to determine what differences exist in student completion, performance, effort, and satisfaction. Our results show better performance from the traditional section when compared to the others. We do not find statistically significant differences in student effort or in student completion. Student satisfaction was high in all sections.

Public health sealant delivery programs: optimal delivery and the cost of practice acts.

Background. The greatest unmet health need for US children is dental care. School-based sealant programs target low-income, high-risk second graders and are effective in preventing caries for as long as the sealant material remains in place. However, it is not clear whether such programs make efficient use of available resources and staffing. Methods. The authors used discrete event simulation to determine the optimal combinations of staffing levels and sealant stations for school-based sealant programs. Using data provided by state programs and the literature, they modeled different-sized programs under different practice act constraints and determined times and associated costs. A detailed economic analysis was done for Wisconsin. Results. For general, direct, or indirect supervision, it is optimal to have only 1 dentist or no dentists for no supervision. For general supervision, it is optimal to have the dentist and dental assistant to come on separate days to screen. The cost savings for adding an assistant and chair averaged over all of the program sizes and travel distances ranged from 4.50% (SE= 0.89) to 10.94% (SE= 0.56). Significant cost savings also result from reducing the required supervision level (8.72% [SE = 1.61] to 29.96% [SE= 1.67]). The cost of the practice act for the state of Wisconsin for 2003 was from

Evaluation of School-Based Dental Sealant Programs: An Updated Community Guide Systematic Economic Review

83,041 to

A Specialized Column Generation Approach for a Vehicle Routing Problem with Demand Allocation

346,156, significantly more than its annual budget. Conclusions. States could save money by relaxing restrictions on the type of personnel who can deliver sealants in public health settings and by productivity gains through proper consideration of staffing. The savings could be used to improve access to sealant programs and further reduce disparities in oral health.

Alternatives for Reducing the Risk of Transmission of Tuberculosis in a Typical Hospital Clinic in Developing African Countries

CONTEXT A recently updated Community Guide systematic review of the effectiveness of school sealant programs (SSPs) still found strong evidence that SSPs reduced dental caries among schoolchildren. This follow-up systematic review updates SSP cost and benefit information from the original 2002 review. EVIDENCE ACQUISITION Using Community Guide economic review methods, the authors searched the literature from January 2000 to November 20, 2014. The final body of evidence included 14 studies-ten from the current search and four with cost information from the 2002 review. Nine studies had information on SSP costs; six on sealant benefit (averted treatment costs and productivity losses); four on SSP net cost (cost minus benefit); and three on net cost to Medicaid of clinically delivered sealants. The authors imputed productivity losses and discounted costs/outcomes when this information was missing. The analysis, conducted in 2015, reported all values in 2014 U.S. dollars. EVIDENCE SYNTHESIS The median one-time SSP cost per tooth sealed was

School-Based Dental Sealant Programs Prevent Cavities And Are Cost-Effective

11.64. Labor accounted for two thirds of costs, and time to provide sealants was a major cost driver. The median annual economic benefit was

Student Perceptions of Online Education

6.29, suggesting that over 4 years the SSP benefit (

Balancing investments in federally qualified health centers and Medicaid for improved access and coverage in Pennsylvania

23.37 at a 3% discount rate) would exceed costs by