A Vehicle Routing Problem for Modeling Home Healthcare: a Case Study

Compared to center-based hemodialysis (HD), peritoneal dialysis (PD) has many advantages among which cost effectiveness and comfort of patients are the most important ones. On the other hand the number of PD patients is so small and even decreasing worldwide due to difficulties of this mode of dialysis. Therefore to encourage dialysis patients to choose PD, health system must provide a proper set of care services proportional to special needs of these patients. Applying operations research (OR) as an efficient mathematical tool and considering the realistic assumptions such as travel time uncertainty, first a Vehicle Routing Problem model is presented to serve PD patients at home with special logistic services. Thereafter, based on the criticality of timeliness in providing healthcare service, a conservative method called robust optimization, is applied to handle time uncertainty. The corresponding results show that the proposed method at the maximum uncertainty level has less than 30% variations in results and in comparison with the deterministic model increases the costs only by 1.2%. With small variations in results, this model can handle the travel time uncertainty properly and is highly appropriate and practical to be used in a sensitive application like healthcare where timeliness is crucial.