With the rapid growth of online healthcare and increasing demand for personalized medical services, the traditional offline outpatient care model is increasingly unable to meet the diverse needs of various patient groups. To better align with patient preferences and improve care quality, this paper presents a multi-period home health care routing and scheduling problem (HHCRSP), in which patients can select among three service modes: outpatient, door-to-door, and online. The study addresses key challenges in real-world home healthcare delivery, including caregiver-patient matching, time window flexibility, and continuity of care. The objective is to optimize caregiver assignments and scheduling decisions across different service modes while minimizing total costs. We formulate the problem as a mixed-integer nonlinear programming model that captures multiple patient time windows and collaboration between online and offline services. To solve this complex problem efficiently, we propose an improved tabu search (ITS) algorithm. The ITS incorporates a dynamic tabu length mechanism, a novel swap-and-change operator for optimizing patients’ service dates, and a forward start interval algorithm for handling multiple time windows. Numerical experiments demonstrate that ITS outperforms the basic tabu search (TS), competitive simulated annealing (CSA), variable neighborhood search (VNS), and random general variable neighborhood search (RGVNS), achieving average improvements of 21.24 %, 12.28 %, 7.81 %, and 1.76 %, respectively, in solution quality. Sensitivity analyses further reveal that the setting of objective function cost parameters, caregiver-patient skill level deviations, and the number of caregiver workdays significantly impact scheduling performance. The research findings provide valuable decision-making support for healthcare staff scheduling.
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