Q&A with Assistant Professor, Dr. Xiang Zhong 

UF ISE sat down with Assistant Professor, Dr. Zhong to discuss her latest research initiatives. Dr. Zhong joined the ISE department in Fall 2016, and has since been moving forward in her research efforts.

JM: What are you currently researching?

XZ: “My most recent research interests are in investigating the impact of health IT such as patient portal and electronic visit on ambulatory care delivery, and address the analysis, design and decision making problems to improve patient access and continuity of care.”


JM: What is innovative about your research?

XZ: “Both patients and providers are not mechanical entities, and they exhibit adaptive and strategic behaviors. Our research aims to develop models that would account for the heterogeneous and adaptive behaviors of patients and providers, and we expect the enhanced models can provide the insights that can lead to better policies and operational guidelines. For instance, the panel size planning and appointment scheduling of outpatient clinics might be significantly affected by the prevalence of active portal users in the patient cohort. Patients’ usage of web-based services might alleviate the congestion of in-person visits, but the care choice is driven by their trust in technology and knowledge about the current appointment delay. Therefore, the design and decision-making should take such features into consideration, which demands new methodologies and tools.”


JM: How is your work distinct from your peers and supervisor?

XZ: “The potential impact of patient portal on ambulatory care delivery has not been explicitly considered in the operations research literature. There is a need for effective methodologies to solve the care delivery issues incurred by portal technology.”


JM: What influences have initiated your research?

XZ: “Patient portal is recognized as a promising mechanism to deliver high quality and accessible ambulatory care by increasing communication between patients and providers, and enhancing information sharing among them. The US Centers for Medicare & Medicaid Services (CMS) has initiated incentive programs to support providers in the period of Health IT transition and instill the use of portals in meaningful ways to help the nation improve the quality, safety, and efficiency of care. However, it inevitably affects demand-supply balance, provider workload, and workflow variability, thereby creating additional operational challenges. Clinical studies have shown that patient portal can significantly influence patient access, provider productivity, and health outcomes. Specifically, working together with health professionals from UF Health Physicians, we have investigated the association between care utilization and portal adoption using patient EMR data, and one major finding is that portal adoption significantly enhanced patients’ appointment adherence. Furthermore, we find that portal access could substitute a proportion of telephone encounters, at the cost of managing more online communications (e.g., messaging). Empirical studies are able to quantify the system dynamics under the conditions of a particular setting in question. Randomized trials are generally not preferable in clinical settings where it could result in moral and legal issues. Hence, it can be difficult to empirically measure a variety of scenarios. By building and analyzing models which incorporate patients’ and providers’ adaptive behaviors, the impact can be estimated for a broader range of scenarios. Thus, we are motivated to develop rigorous analytical tools to study the portal-facilitated care delivery systems, and use them for strategic service design, capacity planning, and operational improvement.”


JM: What do you think are your most significant research accomplishments? What has been the impact of your research?

XZ: “We have established an analytical framework for modeling detailed care delivery operations within medical institutions, and addressed the curse of dimensionality using novel systems approaches (decomposition-aggregation, iteration-based approximation). The models have been applied to analyze ambulatory care delivery operations in hospital units such as CT and breast imaging centers, and primary and specialty clinics to improve their operational efficiency. The proposed systems approaches can address several fundamental methodological challenges in studying healthcare systems (such as large system variability, providers’ limited availability, and patients’ various care pathways), and enrich the literature of modeling complex stochastic systems. The analytical models would enable investigating a broad range of practical scenarios. They would also overcome the computational inefficiency and uncertainty suffered by simulation methods.”


JM: What research topics do you have coming next year?

XZ: “Hospital readmission is an important healthcare performance indicator for quality monitoring, which has attracted substantial research attention. To reduce unplanned hospital readmission, it is imperative to make proper and targeted measures (e.g., medications, phone call and home visit follow-ups, office visits, rehabilitation programs, etc.) tailored to the unique needs of the patient population, and accounting for individual patients’ clinical and psychosocial factors. One research topic we would like to explore is whether patient portal could empower patient-centered intervention, and facilitate patients to engage in their post-discharge care by increasing communication between patients and providers, and enhancing information sharing among them. Another topic along this line is to seek a behavioral explanation for patients’ lack of compliance towards post-discharge medical treatment, with the goal of eliminating compliance barriers for patient engagement. This will establish a series of stochastic modeling and service mechanism design methods geared towards the emerging opportunities and challenges in reducing hospital readmission and providing low-cost high-value care.”

UF ISE looks forward to the new workings of Dr. Zhong. To learn more about Dr. Zhong, visit her website.