A Decomposition Approach to the Clinical Pathway Deployment for Chronic Outpatients with Comorbidities

Most chronic patients with comorbidities are cared for at home. Still, they must get treatments, consultancy, and tests at specialized medical units in a hospital setting, according to a given frequency set by their clinical pathways. As such demand is known in advance, it could be scheduled to ensure ideal frequency, avoid potential visit repetitions that arise in case of comorbidities, and minimize hospital access by pursuing decision coordination. Booking involves setting a date for each health service contained in the pathway, and fixing a time on that day, i.e. building a master plan that spans the planning horizon, and a specific daily agenda for each day. The master plan handles time constraints on the dates, while each daily agenda must comply with the staffing level at each care unit for that day and allow transfer time for patients receiving care at different units. Tackling the master plan together with the daily agendas is rather complex. We present a logic-based Benders decomposition approach where the Master Problem solves the master plan with respect to a relaxation of the units resource constraints, and the subproblems return no-good cuts to the master when their daily agenda problem is not feasible. We present an Answer Set Programming based approach for the Master Problem, as part of a broader project aimed to tackle the whole problem for the first time.