Taewoo Lee’s Projects Deal With Diabetic Retinopathy and Organ Transplants
Taewoo Lee, assistant professor of Industrial Engineering at the UH Cullen College of Engineering, was awarded two grants to address critical issues in health care by the National Science Foundation.
One focuses on making eye care more accessible to at-risk patients with diabetic complications and the other is looking to create smart incentives for organ transplant centers to work equitably with patient needs and government regulations.
“I’m very interested in using mathematical optimization and quantitative modeling skills for improving healthcare delivery and operational systems to help patients who otherwise would not receive good or equitable care,” Lee said.
While pursuing his Ph.D. in operations research at the University of Toronto, Lee worked on optimizing treatment plans involving radiation therapy for cancer patients. This experience showed him the vital role operations research and industrial engineering can play in health care. It also spurred Lee’s interest in broadening his experience involving different types of health issues.
Lee chose to do his postdoctoral work at Rice University because of its proximity to the Texas Medical Center, which happens to be the largest medical complex in the world.
“I found health-related problems in the underserved communities in the United States to be very eye-opening, because when I was in Canada I didn’t see these problems,” Lee said. “The disparities and lack of access for many of these patients, coupled with expensive medical care creates pressing situations that are important to address.”
Lee’s research interests include data-driven optimization and machine learning techniques with results being applicable to various areas of the healthcare industry – operations, medical decision making, cancer therapy, lifestyle management and more.
Here are the details of Lee’s award-winning projects:
Project Title: Collaborative Research: Optimal Design of a Teleretinal Screening Program for At-Risk Patients.
Amount: The total is $254,672 with $169, 792 going to Lee, who is the lead UH investigator.
Diabetic retinopathy (DR) is the most common diabetic eye disease in America and the leading cause of blindness in American adults, affecting more than 30 million diabetic patients.
“One of the biggest problems in diabetic complications is that so many of the diabetic patients are lacking access to eye care. It’s a question of time, expenses and not very convenient locations so a lot of people just skip going for eye care,” Lee said. "Timely treatment can prevent up to 98 percent of DR-related vision loss, but only 30-60 percent of diabetic patients are screened by retina specialists annually.”
As a result, teleretinal screening has recently received increasing attention as an accessible screening technique, where patients first receive examinations at primary care offices or local health centers via non-dilated digital imaging and are referred to specialists if deemed to have threshold disease.
However, several challenges have undermined the effectiveness of teleretinal screening programs. First, little is known how such programs can be expanded and implemented in larger urban settings or rural areas and promote participation of patients with limited access.
Furthermore, there is a lack of quantitative understanding of the trade-offs between teleretinal and in-clinic screening exams for different patient subgroups and program structures and how a personalized screening policy can be developed and integrated with the current system based on the trade-offs.
The main goal of this project is to develop a comprehensive, quantitative modeling framework for an optimal design of a teleretinal screening program from both societal and individual patient's perspectives. Lee will use mathematical optimization, partially observable Markov decision processes in particular, to determine the optimal screening times for the patients, and game-theoretic approaches to integrate them with the societal perspectives.
“The idea is to see how we can make best use of teleretinal screening systems to really benefit the patients that are underserved and falling through the cracks,” Lee said.
The broader impact of this work is immense. The community's consensus is that disparities in access to care and low compliance are the most important issues in the management of DR today, Lee said.
Lee hopes that the results of this research will provide insights into how clinical guidelines can adapt to advances in retinal imaging and how the resources can be shifted to high-risk population in the next-generation of DR screening systems.
“We have partnered with the Harris Health System to enable the implementation of the results of this study in the greater Houston area, and adopted an FDA-cleared automated diagnosis platform to enable the deployment of the devices at various accessible locations,” Lee said.
The other PI on the project is Christina Y. Weng with the Baylor College of Medicine.
Project Title: Collaborative Research: Performance Incentives for Organ Transplantation Centers
Amount: Total funding for the project is $386,251, of which $84,880 is allocated to Lee, who is the lead investigator.
This project goal is to ensure more effective use of donor transplant organs.
“Organ transplantation is the most effective, and often the only viable, therapy for end-stage organ failure. Unfortunately, the demand for organs greatly exceeds the supply,” Lee said. Add to that government regulations and compliance-based Medicare and Medicaid reimbursements involving the centers.
“The regulations sometimes backfire in the sense that the some of the centers can game the system to be compliant,” he added. “Some of the centers might become overly risk-averse because they don’t want to be penalized, which can lead to wasted organs and decreased transplantation volume.”
With the aim to ensure transplant centers effectively use “these scarce organs, we will develop new transplant center evaluation criteria to incentivize transplant centers to improve their post-transplant outcomes and maximize transplantation volume at the same time,” he added.
Other institutions involved in the project are Rice University and Houston Methodist Hospital.
The researchers hope to gain a deeper understanding of current pay-for-performance initiatives in the transplantation system and in other healthcare settings by examining the interplay between societal goals and provider incentives.
This research will build a bilevel optimization framework to model the interaction between the societal perspective and the goals of individual transplant centers to determine incentives that simultaneously maximize societal and center-level benefits. This framework (1) formulates the societal perspective (the leader) that quantifies the utility-adjusted, national benefit and determines societally optimal incentive parameters, and (2) models each transplant center's perspective (the followers) as a sequential, stochastic decision-making problem so as to maximize its transplant volume subject to the societal incentives.
“The motivation for both of the projects is how to connect these multiple stakeholders using the technologies and techniques that we have,” Lee said. “We want to align the different views and agendas, and smartly design systems to make the processes better, efficient and more consistent, which will definitely benefit the patients.”