Reallocation of chemotherapy appointments in a large health system using a mixed integer linear programming approach

Outpatient chemotherapy scheduling has significant implications for both patients and health systems. Consideration of treatment location preference is important for patient satisfaction and outcomes, and it is a complex decision impacted by travel distance. In health systems with one treatment site that stands out from the rest as a destination medical center (the primary site), there are financial and resource utilization incentives to free up as much space as possible for appointments at that site. In this study, we demonstrate that leveraging the underutilized health system sites allows decompression of appointment volume at the primary site, and it takes full advantage of valuable resources such as oncology nurses and chair availability. A Mixed Integer Linear Programming approach was used to develop a model under four scenarios which reallocates appointments from the primary site to other health system sites based on patient travel distance to the sites. This approach was applied to data from the Mayo Clinic Health System Minnesota region, which demonstrated that the health system has the potential to move approximately 50% of eligible appointments out of the primary site, resulting in an overall volume change of approximately 30%. Implications for scheduling policies and infrastructure are discussed.