Sait Tunc receives NSF CAREER award to optimize health care systems for equitable outcomes

In an effort to revolutionize the health care system through operations research and systems engineering, Sait Tunc, an assistant professor in the Grado Department of Industrial and Systems Engineering, has received a National Science Foundation Faculty Early Career Development (CAREER) award.

The CAREER program supports early career faculty who have the potential to serve as academic role models in research and education and lead advances in the missions of their department or organization. This five-year grant totaling $568,619 will support Tunc’s research on inefficiencies in health care systems, particularly with respect to organ transplants. And it couldn’t be more timely.

Tunc’s research regarding organ utilization comes at a pivotal time in the industry. While organ scarcity exists, there is also a significant level of underutilization. Roughly 25 percent of organs recovered from deceased donors go unused for a variety of reasons. Patients may refuse organ offers because they come from a relatively higher risk donor, or they may choose to wait to see if another “better” organ becomes available. Additionally, patients with access to higher quality health care may receive special priority.

“I want to identify disadvantaged patients and improve their access to organs. Federal law prevents penalizing patients for rejecting organ offers, which creates a gap between what is optimal for the individuals and how they behave. One mechanism I developed identifies disadvantaged patient groups who have reduced access to organs, thus a higher mortality rate,” Tunc said.

In addition to matching organs to recipients more efficiently, Tunc also wants to ensure equitable access for all in need. Perhaps surprisingly, this means taking into consideration voluntary incentive mechanisms, which prioritize motivating patients based on data rather than removing the option of choice. For example, instead of mandating participation, such as forcing a patient to accept an organ of relatively lower quality, voluntary incentive mechanisms give patients agency by showing them why they could reject an organ, but why they’d be better off accepting it rather than, say, remaining on dialysis.

“We use data modeling to prioritize these patients for organ offers that are most beneficial to them. This improves the match between donors and recipients and addresses the issue of organ underutilization,” Tunc said. “The challenge in organ procurement is not just about finding more donors, but ensuring that the organs are used efficiently and equitably. I want to bridge the gap between what is best for society and how individuals behave.”

Incentivizing healthy behavior

Voluntary incentive mechanisms work at large-scale and individual levels, and Tunc’s research addresses both. He investigates how these strategies lead to an increase in wellness-related behaviors, such as exercise or tobacco cessation. This aspect of his proposal aims to encourage healthier behaviors considering that not everyone has the same level of delay discounting and using someone’s willingness to adopt healthier activities based on what reward they would receive if they change their habits.

“My primary goal with this research is to design and implement voluntary incentive mechanisms in the health care field, for both organizations and individuals,” Tunc said. “Rather than use coercion or mandated participation, voluntary incentive mechanisms encourage participants through rewards. These tend to make implementing new strategies easier compared to traditional approaches in health care and improve outcomes at the individual, organizational, and societal levels.”

Using voluntary incentive mechanisms, Tunc’s research seeks to

•  Alleviate the burden of organ scarcity, reduce the size of the transplant waiting list, improve the access of marginalized groups to transplants, and mitigate waitlist deaths
• Partner with Organ Procurement Organizations to expand organ availability and overall procurement
• Reduce disparities in transplant access, especially for those at a significant disadvantage, including older patients and patients of color
• Align individual actions with societal health goals, promote healthy behaviors, and improve long-term health outcomes especially among those most in need, such as individuals living with addiction or obesity

As part of the National Science Foundation’s support for educational outreach, the impacts of Tunc’s award will span from undergraduate engineering students to medical professionals, including a partnership with Virginia Tech Carilion School of Medicine and Virginia State University (VSU).

Health care providers can adjust their response to patients based on their willingness to adopt healthier behaviors. Tunc is hopeful this strategy will encourage people to adopt healthier habits while feeling they have choices in their decision making.

“It’s crucial to design programs that actually motivate people to adopt healthier behaviors by considering all these individual differences in delay discounting, which explains why some people might not find long-term rewards as enticing. People that show addictive behavior, for example, are typically associated with higher delay discounting,” Tunc said. “This will enable researchers to find strategies that work for different groups.”

The future of health care systems

Tunc plans to use this research as an opportunity to educate others on how operations research and systems engineering and the use of voluntary incentive mechanisms can be beneficial for those working in the health care field, including short courses for medical students on implementing voluntary incentive mechanisms, and research education that will benefit undergraduate and graduate students at Virginia Tech and beyond.

"Our partnership with VSU is quite detailed, providing summer undergraduate research assistantship opportunities for VSU students at Virginia Tech, and offering an in-person opportunity for them to engage with groups in our department and elsewhere at the university,” Tunc said. “We hope we can engage students from multiple backgrounds and disciplines to participate, and encourage them to consider health care-related studies.”

Tunc’s grant-related research has informed his curriculum, including two new graduate level courses addressing health systems. Looking even further, Tunc hopes the research will impact policymakers from the top down while solving this complex global challenge.

"Beyond the direct educational interventions, the outreach activities associated with this research aim for policy change at the national level,” Tunc said. “Engaging with key stakeholders and policymakers ensures that the outcomes of this research are understood and potentially integrated into the national health care system.”