Date of Graduation

7-2015

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Engineering (PhD)

Degree Level

Graduate

Department

Industrial Engineering

Advisor

Ashlea B. Milburn

Committee Member

Ed Pohl

Second Committee Member

Justin R. Chimka

Third Committee Member

Jessica L. Heier Stamm

Keywords

Applied sciences; Health and environmental sciences; 2SFCA; Home healthcare; Spatial accessibility; Spatial regression; System dynamics; Telehealth

Abstract

Home healthcare is becoming an important alternative to institutionalized care. It not only reduces costs but also increases health outcomes and patient satisfaction. However, the availability and efficiency of home healthcare services need to be improved as the aging population increases in the US. Hence, understanding home healthcare utilization and access are the essential steps to develop strategies ensuring effective and sustainable services to patients.

This research aims to study two main issues in the US home healthcare system: diffusion and long-term impacts of home telehealth and potential spatial accessibility of home healthcare services. Home telehealth is a promising technology that can increase efficiency and health outcomes. However, the diffusion of this technology has been slow basically due to lack of reimbursement and lack of evidence on its impacts. In the first part of this dissertation, we study the innovation characteristics affecting home telehealth diffusion among agencies and develop a system dynamics model to demonstrate the impacts of home telehealth on healthcare utilization and overall healthcare cost. Next, we study the potential spatial access to home healthcare services. Potential spatial accessibility refers to the availability of a service in a given area based on geographical factors, such as distance and location. In this part of the dissertation, a new measure that simultaneously considers both staffing levels and eligible populations is developed and used in a case study to highlight the spatial disparities in access in Arkansas. To the best of our knowledge, no previous measure has been proposed to quantify the potential spatial accessibility of home healthcare services within a geographic region. Then, we examine the factors that are associated with accessibility across the study region by space-varying coefficient models. The results of this part of the dissertation can inform policies that positively impact access to home healthcare services.

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