A Novel Simulation Framework for Evaluating and Optimizing Oncology Outreach Policies in a Regional Cancer System

BACKGROUND: Oncology outreach is a common strategy for addressing cancer workforce shortages, where traveling oncologists commute across healthcare settings to extend specialized care. However, methods for evaluating and optimizing outreach strategies are limited. METHODS: We developed a simulation framework for evaluating and optimizing potential outreach strategies and applied it to two test cases within Dartmouth Health's hub-and-spoke cancer system. Our approach involved sampling incident patients and visit capacity across oncologist/site pairs, assigning patients to oncologist/site pairs, and estimating the total patient travel time incurred across two groups: (1) where a portion of patient visits is shifted from the hub facility to a satellite, and (2) where the original distribution of patient visits is retained. After 5000 simulations, the mean difference in patient travel time among groups was computed to estimate patient travel time savings. We identified the optimal number of new patient visits to reallocate from the hub to satellite that maximized patient travel time savings. RESULTS: We identified satellites in St. Johnsbury, VT and Manchester, NH as candidates for increased medical and radiation oncology outreach, respectively. At St. Johnsbury, we found that reallocating 45% of new medical oncology visits resulted in 140 (95% CI: 97-174) total hours saved. For patients whose care was shifted, this corresponded to an average of 1.07 (95% CI: 0.75-1.34) hours saved per visit. At Manchester, we found that reallocating 50% of new radiation oncology visits resulted in 55 (95% CI: 34-71) total hours saved. For patients whose care was shifted, this corresponded to an average of 1.13 (95% CI: 0.70-1.44) hours saved per visit. CONCLUSION: Simulations offer a valuable means to assess the effectiveness and uncertainty of potential outreach strategies. Such approaches are well positioned to provide administrative decision support for health systems and can be leveraged to inform directional investments in outreach policies.