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Finding the optimal geographic location for a medical service is a common challenge for healthcare organizations. However, there is limited use or description of methods to determine the optimal location of a medical service. We describe a case study of how location-allocation techniques used by industrial engineers assisted a regional healthcare network develop a plan for optimal location of sleep medicine services within its network.

Optimal location of specialty care services within any healthcare network is increasingly important for balancing costs, access to care, and patient-centeredness. Typical long-range planning efforts attempt to address a myriad of quantitative and qualitative issues, including within-network access within reasonable travel distances, space capacity constraints, costs, politics, and community commitments. To help inform these decisions, single and multi-period mathematical integer programs were developed that minimize total procedure, travel, non-coverage, and start-up costs to increase network capacity subject to access constraints. These models have been used to help the Veterans Health Administration (VHA) explore relationships and tradeoffs between costs, coverage, service location, and capacity and to inform larger strategic planning discussions. Results indicate significant opportunity to simultaneously reduce total cost, reduce total travel distances, and increase within-network access, the latter being linked to better care continuity and outcomes. An application to planning short and long-term sleep apnea care across the VHA New England integrated network, for example, produced 10–15% improvements in each performance measure. As an example of further insight provided by these analyses, most optimal solutions increase the amount of outside-network care, contrary to current trends and policies to reduce external referrals.

Post-traumatic stress disorder (PTSD) is associated with poor health but there is a gap between need and receipt of care. It is useful to understand where to optimally locate in-person care and where video-based PTSD care would be most useful to minimize access to care barriers, care outside the Veterans Affairs system, and total costs. We developed a service location systems engineering model based on 2010 to 2020 projected care needs for veterans across New England to help determine where to best locate and use in-person and video-based care. This analysis determined specific locations and capacities of each type of PTSD care relative to patient home locations to help inform allocation of mental health resources. Not surprisingly Massachusetts, Connecticut, and Rhode Island are well suited for in-person care, whereas some rural areas of Maine, Vermont, and New Hampshire where in-patient services are infeasible could be better served by video-based care than external care, if the latter is even available. Results in New England alone suggest a potential $3,655,387 reduction in average annual total costs by shifting 9.73% of care to video-based treatment, with an average 12.6 miles travel distance for the remaining in-person care.