Value-based Learning Healthcare Systems: Integrative Modeling and Simulation
2: University of Clermont Auvergne, France
3: National Institute of Mines and Telecom (IMT), Mines of Alès Engineering School, France
4: International Research Center in Agronomy and partnership for the Development (CIRAD), France
Achieving value-based healthcare - increasing quality, reducing cost, and spreading access - has proven to be extremely challenging, in part due to research that is siloed and largely focused on singular risk factors, ineffective care coordination resulting from service fragmentation, and costly unintended consequences of reform that have emerged due to the complexity of healthcare systems. Understanding the behavior of the overall system is becoming a major concern among healthcare managers and decision-makers intent on increasing value for their systems. This book fills a gap in the literature that is becoming more evident as reform efforts proliferate: a holistic Modeling and Simulation (M&S) approach to value-based healthcare within a framework that enables designing, testing and implementing concepts to integrate resource allocations, health phenomenon dynamics, individual behavior, and population dynamics. It presents a pathways-based efficient coordination of care model involving all stakeholders including patients, providers, care deliverers, managers, and payers. It shows how M&S can help design a better service infrastructure and describes the information technologies that are necessary to implement it successfully. It also presents global and national healthcare perspectives from Europe, USA, Asia and Africa, as well as research directions needed to realize the value-based M&S healthcare vision.
Inspec keywords: medical computing; health care
Other keywords: value-based learning health care systems; pathways-based care coordination; medical computing
Subjects: General and management topics; Biology and medical computing
- Book DOI: 10.1049/PBHE015E
- Chapter DOI: 10.1049/PBHE015E
- ISBN: 9781785613265
- e-ISBN: 9781785613272
- Page count: 372
- Format: PDF
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Front Matter
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Part I - Modeling and simulation framework for value-based healthcare systems
Part I - Modeling and simulation framework for value-based healthcare systems
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1 Healthcare systems modeling and simulation
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Healthcare systems modeling and simulation has a broad application around different disciplines such as clinical simulation, operational simulation, managerial simulation, and educational simulation. However, the domain of healthcare is characterized by a high degree of complexity and a diversity of facets, and modelers are often confronted with the challenge of formulating a simulation model that captures this complexity in a systematic and manageable manner. This chapter reviews frequently used M&S-related concepts to address the problem, concluding clinical and epidemiologic simulations are predominant in the literature.
2 Multi-perspective architecture for holistic healthcare M&S
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In this chapter, we introduce a framework based on four perspectives, which allows multi-perspective modeling and holistic simulation of healthcare systems. Interactions between models of different perspectives are realized by dynamic update of models through output-to-parameter integration during concurrent simulations. Such an approach provides multiple levels of explanation for the same system, while offering, at the same time, an integrated view of the whole. The novelty of our approach is that notable components of the healthcare system are modeled as autonomous systems that can influence and be influenced by their environments. The resulting global model can be coupled with a holistic experimental frame to derive results that could not be accurately addressed in any of the perspective taken alone.
3 Formalization of the multi-perspective architecture
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In this chapter, we formalize the multi-perspective architecture framework using the system-theoretic paradigm provided by the discrete event system specification (DEVS) formalism. The developed integration approach that allows linking up the isolated perspectives has been formalized through a concept based upon DEVS formalism called parameterized DEVS, whereby concurrent simulation processes cause live update through output-to-parameter integration. This sets up the basis for development of DEVS-based holistic models for efficient management of healthcare systems. Results of real case-based simulations are presented to show how holistic models provide new insights not heretofore attainable with unit and facility specific models.
4 Methodological elements for simulation-based healthcare management
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Modeling complex systems where different aspects of the system are captured by different views have been reported as hard. Usually, the required knowledge to do so is distributed among various stakeholders. Bringing them together is not an obvious operation. In this chapter, we examine some salient aspects of that issue. Three concerns are scrutinized: The heterogeneous nature of healthcare systems M&S, in terms of spatial and temporal scales involved; the importance of a visual language to capture all the modeling knowledge while interacting with experts from various domains: we introduce the High Level Language for System specification (HiLLS), a system modeling language for constructing multi-analysis system models, which can be seen as a visual language for DEVS; the hybrid nature of healthcare systems M&S, where hybridization occurs both at conceptual and operational levels. We also have a look on participatory modeling (PM) as a way to involve nonexperts at the conceptual level of the modeling process in order to increase the set of available knowledge for making useful decisions.
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Part II - Modeling and simulation of pathways-based care coordination
Part II - Modeling and simulation of pathways-based care coordination
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5 DEVS methodology for coordination modeling
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At the system-of-systems (SoS) level, care coordination is the organization of all activities, both clinical and extra-clinical, among the individual patient and providers involved in the patient's care to facilitate the appropriate delivery of healthcare services. In this part, we expanded upon a system-of systems engineering (SoSE) formalization and simulation modeling methodology for a more in-depth application of discrete event systems specification (DEVS) coordination pathways to reengineer healthcare service systems.
6 Care coordination and pathways-based experimental frames
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This chapter provided a brief review of the original formulation of the Pathways Community HUB model. This review set the context for the multiperspective modeling and simulation framework and its support of pathways-based care coordination. We then discussed the discrete event system specification (DEVS) formalization of pathways in more depth and showed how pathways serve as a basis for quality improvements in coordination of care. The DEVS formalization provides a firm basis for computerized support for monitoring, tracking, and reporting. This leads to improved client adherence to their assigned activities and improved coordination among the payers and agencies involved.
7 Pathways-based care coordination simulation example
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This chapter discusses a simulation framework to guide design, development, and evaluation of architectures for pathways-based coordination of care. A simulation model was presented that exemplifies this framework and is intended to predict ROI for implementing pathways-based coordination as well its sustainability over the long term. The model does not include dimensions such as client risk characteristics, the referral source of clients to the coordination program, the effect of incentives on service workers' performance, and alignment of pathways with payments. Including these dimensions would be needed to increase the predictive capability to address questions about pathways that are important for their implementation in value-based healthcare.
8 Health information technology support for pathways-based care
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We have presented an approach to ensuring pathways client data validity and improving the design of associated health information infrastructure for community-based coordination of care. Beyond making explicit the aspects in which data quality can fall short, the approach has been shown to inform the design of decision support systems for community health workers and other participants in the Pathways Community HUB. We exploited the existence of pathways structures to organize the data using formal systems concepts to develop an approach that is both well-defined and applicable to support general standards for certification of such organizations. The presentation showed that pathways structures are an important principle not only for organizing the activities of coordination of care but also for structuring the data stored in electronic health records in the conduct of such care. We also showed how it encourages design of effective decision support systems for coordinated care and suggested how interested organizations can set about acquiring such systems.
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Part III - Application of the framework
Part III - Application of the framework
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9 Pathways-based coordination of care in rural France
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In this chapter, we proposed a new architecture that covers two different aspects: technical aspect related to the interoperability between BPMN and DEVS and a health aspect related to the inequality of the geographical physicians' distribution, and to the long waiting times.
10 Surveillance of avian influenza in Vietnam
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In this chapter, we present the surveillance of a zoonosis in Vietnam, the highly pathogenic avian influenza (HPAI). Birds are the natural hosts for avian influenza (AI) viruses and some subtypes, such as H5N1 and H7N9, can be transmitted to human with severe consequences in term of morbidity and mortality. We illustrate how an integrated approach to health applied to zoonosis is achieved by using participatory modeling and a DEVS approach.
11 Multi-perspective modeling in relation to complex adaptive systems
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Advocating that healthcare should be considered as a complex adaptive system (CAS), Kuziemsky indicates that an acknowledged shortcoming in much of the existing research is that it is descriptive in nature without guidance on how to study healthcare delivery as a CAS. Kuziemsky offers an informal system model that is intended to establish understanding of how the system works with respect to the relevant concepts and the relationships. He illustrates how various and costly unintended consequences have emerged from steps taken to reform healthcare systems due to the complexity of the pertinent healthcare processes. Before proceeding, we briefly review some relevant background on CAS. We then consider fundamental requirements for modelling and simulation of CAS in the context of health care.
12 Extending the framework to value-based coordination architectures
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In this chapter, we discuss the need for extending the modeling and simulation methodology discussed in the book to this point to develop a suite of simulations to study specific approaches to value-based delivery of services. The focus is on coordinated care with the goal of enabling design and development of architectures that treat patients as agents interacting with systems and services that are coordinated using health information networks and interoperable electronic medical records. Success in this direction will contribute to the major global healthcare goal of solving the iron triangle reducing cost while improving quality and increasing access. Our specific goal is to allow organizations such as public health departments, hospitals, and new kinds of organizations (such as ACOs in the United States) to evaluate specific coordinated care strategies, proposed payment models, and potential trade-offs between quality and cost of coordinated care. A range of simulation tools must be developed to support the design of coordination architectures and predict important quality metrics that are applicable to diverse populations.
Epilogue: Where do we go from here—Global and National Healthcare Maturity
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In this epilogue, we place the technical discussion of the book into global national healthcare perspectives. To set the framework for such a discussion, we introduce the concept of maturity levels. Then, we discuss what it would take for a system to move up from where it is to the top maturity level and how using this book can help.
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Back Matter
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