There has been tremendous progress in medicine, improving the diagnosis and treatment for many diseases, and yet, healthcare delivery in the United States is still associated mostly with clinics, hospitals, pharmacies, etc. and our nation continues to struggle with many challenges including morbidity and mortality due to preventable causes.

“Health care happens everywhere including our everyday environments and in our adherence to preventive measures like vaccinations,” said Pinar Keskinocak, PhD. Dr. Keskinocak is William W. George Chair and Professor in the H. Milton Stewart School of Industrial and Systems Engineering and Director of the Center for Health and Humanitarian Systems at Georgia Tech.

Dr. Keskinocak’s research and projects include many aspects of health systems, such as medical decision-making, disease modeling and evaluating interventions, and healthcare operations management.

“Do the right things upstream” to alleviate clinical burden, reduce costs and improve population health

One of Dr. Keskinocak’s passions in healthcare is to shift the focus from sick care to health care, expanding resources and efforts to prevention promoting health and well being.

“Doing the right things upstream to keep people out of ‘sick care’ environments, such as emergency rooms, is something our research attempts to influence utilizing modeling and analytics,” Dr. Keskinocak said. “The more we can do to reduce the populations’ need for sick care, the more scarce resources can be dedicated to those who need it most.”

One area where medicine and public health successfully came together for the prevention of infectious diseases is childhood vaccinations.

“Recommended vaccination schedules as well as children’s access to vaccinations often vary by region/country or subpopulation; hence, increasing vaccination rates and ensuring equitable access to preventive services are especially valuable in pediatric disease prevention.”

According to the Centers for Disease Control and Prevention, half of children in the United States fall behind on recommended vaccinations by 24 months of age, a problem exacerbated by the COVID-19 pandemic according to data from the World Health Organization and UNICEF.

“When someone falls behind [on the recommended vaccination schedule], the standard recommended schedule no longer applies,” she said. “Catchup schedules need to be personalized, considering the child’s age and vaccination history, and implemented in a way that increases the chances of timely access to vaccinations.”

According to Dr. Keskinocak, creating personalized catch-up schedules is a complex task, given the number of doses, the timing of those doses, age and other considerations.

Using technology to personalize “catch up” vaccination schedules

“Our work on optimizing personalized ‘catch-up’ schedules for vaccinations started in collaboration with the CDC in 2007. That work continues today with other partners, to incorporate new vaccination recommendations, parameters, and schedules.

“Personalized catch-up schedules reduce the burden on the individuals, their families, providers and our health systems as a whole. ”

As an example of prevention for non-infectious diseases, Dr. Keskinocak points to children with asthma, a particularly acute problem in Georgia.

Environmental mitigation efforts including in the home can significantly reduce adverse events, such as asthmatic attacks for children, who might end up in emergency rooms.Similarly, access to the right kind of preventive measures and medications used as directed can reduce the need for urgent ‘sick care.’

“Management of chronic conditions like childhood asthma can significantly reduce the burden on the individuals and their families, as well as hospitals or clinics and the health system as a whole!”

A recent publication co-authored by Dr. Keskinocak utilizes difference-in-difference regression to quantify the effect of the intervention on the probability of asthma-related healthcare utilization, asthma medication, and utilization costs.

“Asthma self-management education, nebulizer, and spacer interventions reduced the probability of emergency department (20.8-1.5%, 95%CI 19.7-21.9% vs. 0.5-2.5%, respectively) and inpatient (3.5-0.8%, 95%CI 2.1-4.9% vs. 0.4-1.2%, respectively) utilizations. Influenza vaccine decreased the probability of primary care physician (6-3.5%, 95%CI 4.4-7.6% vs. 1.5-5.5%, respectively) visit. The reductions varied by state and intervention.”

“One of the key findings, which should be of interest to policymakers, is that all four interventions were associated with lower medication costs and utilization costs,” [lead-author Julie] Swann says.

Healthcare innovation isn’t always about “widgets”

Technologies that improve pediatric care based on clinical needs are not always ‘widgets,’ virtual or tangible. Improvements in clinical workflows or personalized vaccination schedules, for example, can reduce burdens not associated with direct provision of care, reducing waiting times, improving patient satisfaction and outcomes among other benefits. Sometimes meaningful acceleration in innovation comes in the form of efficiency gains, research, or decision-support tools.

Georgia Tech Pediatrics is proud to support work in the realm of process improvement and preventive medicine that improves the provision of pediatric care and the lives of those children at home and across the globe. We thank Dr. Keskinocak for sharing part of her story and work here.