Optimal Timing of Medical Decisions

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Questions regarding the proper timing of various medical interventions arise frequently in health care. How often should patients go for laboratory tests to measure the progress of an existing disease? What is the optimal time to initiate a therapy or to switch therapies when one appears to lose its effectiveness? These are difficult decisions because of the need to trade off costs and benefits under uncertainty. My research program aims to develop and apply advanced analytical techniques from the field of operations research (OR) to aid decision making for these types of clinical timing questions. The methodological tools of OR were designed specifically to deal with complex decision making under uncertainty, and have been applied for over 50 years in a variety of application areas. As medical decision making has become increasingly complex and costly, and patient medical data has become more readily available, these techniques have become extremely relevant for seeking cost-effective solutions to health care problems. Clinical timing decisions alone provide a large class of difficult decisions that are well suited for study using these analytical techniques. Two specific projects will involve key timing decisions concerning patients with chronic kidney disease (CKD): 1) when is the optimal time to prepare an arteriovenous (AV) fistula for patients who eventually start dialysis, and 2) how often should patients on the kidney transplant waitlist be screened for comorbidities that may put them at increased surgical risks should a donation become available? Investigating these questions will require the development of validated, data-driven decision models, and their solutions will require the development of advanced OR methods. This reseach has the potential to benefit the many patients living with CKD as well as the health care organizations that treat them.