Assessing the impact of COVID-19 measures on COPD management and patients: A simulation-based decision support tool for COPD services in the UK

© 2022 The Author(s) or their employer(s). Published by BMJ. This is an open access article under the CC BY-NC-ND licence, https://creativecommons.org/licenses/by-nc-nd/4.0/Objectives To develop a computer-based decision support tool (DST) for key decision makers to safely explore the impact on chronic obstructive pulmonary disease (COPD) care of service changes driven by restrictions to prevent the spread of COVID-19.  Design The DST is powered by discrete event simulation which captures the entire patient pathway. To estimate the number of COPD admissions under different scenario settings, a regression model was developed and embedded into the tool. The tool can generate a wide range of patient-related and service-related outputs. Thus, the likely impact of possible changes (eg, COVID-19 restrictions and pandemic scenarios) on patients with COPD and care can be estimated.  Setting COPD services (including outpatient and inpatient departments) at a major provider in central London.  Results Four different scenarios (reflecting the UK government's Plan A, Plan B and Plan C in addition to a benchmark scenario) were run for 1 year. 856, 616 and 484 face-to-face appointments (among 1226 clinic visits) are expected in Plans A, B and C, respectively. Clinic visit quality in Plan A is found to be marginally better than in Plans B and C. Under coronavirus restrictions, lung function tests decreased more than 80% in Plan C as compared with Plan A. Fewer COPD exacerbation-related admissions were seen (284.1 Plan C vs 395.1 in the benchmark) associated with stricter restrictions. Although the results indicate that fewer quality-adjusted life years (in terms of COPD management) would be lost during more severe restrictions, the wider impact on physical and mental health must also be established.  Conclusions This DST will enable COPD services to examine how the latest developments in care delivery and management might impact their service during and beyond the COVID-19 pandemic, and in the event of future pandemics.Peer reviewe

Examining HIV and Tuberculosis Using a Decision Support Systems Computer Simulation Model: The Case of the Russian Federation

The aim of this paper is to describe the development and use of a computer simulation model that can be used as a Decision Support System (DSS) to tackle the critical public health issues of the chronic diseases, HIV and HIV related Tuberculosis in the Russian Federation. The model was developed to enable health officials and decision makers to determine the impact of policies to control the chronic diseases spread in an area of Russia. This area, like many others in Russia and elsewhere, have recently witnessed an explosion of HIV infections and a worrying spread of the Multi Drug Resistant form of Tuberculosis (MDRTB). The conclusions drawn is that a high population coverage with Highly Active Anti Retroviral Treatment (HAART) (75% or higher), allied with high MDRTB cure rates, reduces cumulative deaths by 60%, with limited impact below this level. The contributions that this research offers are the development of a simulation model that can be applied as a DSS by public health officials and managers in order to inform policy making. By doing so, ways of best controlling the spread of HIV and MDRTB and reduce the mortality rate from these serious public health threats is provided

A simulation-based decision support tool for informing the management of patients with Parkinson’s disease

This is an Accepted Manuscript of an article published by Taylor & Francis Group in International Journal of Production Research, on 9 April 2015, available online via: http://dx.doi.org/10.1080/00207543.2015.1029647We describe a decision support toolkit that was developed with the aim of assisting those responsible with the management and treatment of Parkinson’s disease (PD) in the UK. Having created a baseline model and established its face validity, the toolkit captures the complexity of PD services at a sufficient level and operates within a user friendly environment, that is, an interface was built to allow users to specify their own local PD service and input their own estimates or data of service demands and capacities. The main strength of this decision support tool is the adoption of a team approach to studying the system, involving six PD specialist nurses across the country, ensuring that variety of views and suggestions are taken as well as systems modelling and simulations. The tool enables key decision makers to estimate the likely impact of changes, such as increased use of community services on activity, cost, staffing levels, skill-mix, and utilisation of resources. Such previously unobtainable quantitative information can be used to support business cases for changes in the increased use of community services and its impact on clinical outcomes (disease progression), nurse visits and costing.Peer reviewedFinal Accepted Versio

Using system dynamics modelling to assess the economic efficiency of innovations in the public sector - a systematic review.

BackgroundDecision-makers for public policy are increasingly utilising systems approaches such as system dynamics (SD) modelling, which test alternative interventions or policies for their potential impact while accounting for complexity. These approaches, however, have not consistently included an economic efficiency analysis dimension. This systematic review aims to examine how, and in what ways, system dynamics modelling approaches incorporate economic efficiency analyses to inform decision-making on innovations (improvements in products, services, or processes) in the public sector, with a particular interest in health.Methods and findingsRelevant studies (n = 29) were identified through a systematic search and screening of four electronic databases and backward citation search, and analysed for key characteristics and themes related to the analytical methods applied. Economic efficiency analysis approaches within SD broadly fell into two categories: as embedded sub-models or as cost calculations based on the outputs of the SD model. Embdedded sub-models within a dynamic SD framework can reveal a clear allocation of costs and benefits to periods of time, whereas cost calculations based on the SD model outputs can be useful for high-level resource allocation decisions.ConclusionsThis systematic review reveals that SD modelling is not currently used to its full potential to evaluate the technical or allocative efficiency of public sector innovations, particularly in health. The limited reporting on the experience or methodological challenges of applying allocated efficiency analyses with SD, particularly with dynamic embedded models, hampers common learning lessons to draw from and build on. Further application and comprehensive reporting of this approach would be welcome to develop the methodology further

A Discrete Event Simulation model to evaluate the treatment pathways of patients with Cataract in the United Kingdom

Background The number of people affected by cataract in the United Kingdom (UK) is growing rapidly due to ageing population. As the only way to treat cataract is through surgery, there is a high demand for this type of surgery and figures indicate that it is the most performed type of surgery in the UK. The National Health Service (NHS), which provides free of charge care in the UK, is under huge financial pressure due to budget austerity in the last decade. As the number of people affected by the disease is expected to grow significantly in coming years, the aim of this study is to evaluate whether the introduction of new processes and medical technologies will enable cataract services to cope with the demand within the NHS funding constraints. Methods We developed a Discrete Event Simulation model representing the cataract services pathways at Leicester Royal Infirmary Hospital. The model was inputted with data from national and local sources as well as from a surgery demand forecasting model developed in the study. The model was verified and validated with the participation of the cataract services clinical and management teams. Results Four scenarios involving increased number of surgeries per half-day surgery theatre slot were simulated. Results indicate that the total number of surgeries per year could be increased by 40% at no extra cost. However, the rate of improvement decreases for increased number of surgeries per half-day surgery theatre slot due to a higher number of cancelled surgeries. Productivity is expected to improve as the total number of doctors and nurses hours will increase by 5 and 12% respectively. However, non-human resources such as pre-surgery rooms and post-surgery recovery chairs are under-utilized across all scenarios. Conclusions Using new processes and medical technologies for cataract surgery is a promising way to deal with the expected higher demand especially as this could be achieved with limited impact on costs. Non-human resources capacity need to be evenly levelled across the surgery pathway to improve their utilisation. The performance of cataract services could be improved by better communication with and proactive management of patients.Peer reviewedFinal Published versio

Evaluation of a whole system approach to diet and healthy weight in the east of Scotland: Study protocol

Obesity is a global epidemic affecting all age groups, populations and income levels across continents. The causes of obesity are complex and are routed in health behaviours, environmental factors, government policy and the cultural and built environment. Consequently, a Whole System Approach (WSA) which considers the many causes of obesity and shifts the focus away from individuals as points of intervention and puts an emphasis on understanding and improving the system in which people live in is required. This protocol describes a programme of research that will: critically evaluate the evidence for WSAs; assess longitudinally the implementation of a WSA to diet and healthy weight to explore the range of levers (drivers) and opportunities to influence relevant partnerships and interventions to target obesity in East Scotland. The programme consists of four workstreams within a mixed methods framework: 1) Systematic review of reviews of WSAs to diet and healthy weight; 2) Longitudinal qualitative process evaluation of implementing two WSAs in Scotland; 3) Quantitative and Qualitative momentary analysis evaluation of a WSA; and 4) the application of System Dynamics Modelling (SDM) methodology to two council areas in Scotland. A Public Involvement in Research group (PIRg) have informed each stage of the research process. The research programme’s breadth and its novel nature, mean that it will provide valuable findings for the increasing numbers who commission, deliver, support and evaluate WSAs to diet and healthy weight nationally and internationally

System Dynamics modelling to formulate policy interventions to optimise antibiotic prescribing in hospitals

© 2020 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Multiple strategies have been used in the National Health System (NHS) in England to reduce inappropriate antibiotic prescribing and consumption in order to tackle antimicrobial resistance. These strategies have included, among others, restricting dispensing, introduction of prescribing guidelines, use of clinical audit, and performance reviews as well as strategies aimed at changing the prescribing behaviour of clinicians. However, behavioural interventions have had limited effect in optimising doctors’ antibiotic prescribing practices. This study examines the determinants of decision-making for antibiotic prescribing in hospitals in the NHS. A system dynamics model was constructed to capture structural and behavioural influences to simulate doctors’ prescribing practices. Data from the literature, patient records, healthcare professional interviews and survey responses were used to parameterise the model. The scenario simulation shows maximum improvements in guideline compliance are achieved when compliance among senior staff is increased, combined with fast laboratory turnaround of blood cultures, and microbiologist review. Improving guideline compliance of junior staff alone has limited impact. This first use of system dynamics modelling to study antibiotic prescribing decision-making demonstrates the applicability of the methodology for design and evaluation of future policies and interventions.Peer reviewe

Adoption and use of e-government services in the Abu Dhabi police force : a qualitative study

Information and Communication Technologies (ICTs) are becoming increasingly prevalent in peoples’ daily lives due to the presence of e-government. This research-in-progress paper aims to identify and understand factors affecting the diffusion, adoption and use of e-services in a public sector organisation, in this case, Abu Dhabi Police Force (ADPF) in the United Arab Emirates (UAE). A qualitative approach involving 39 participants’ interviews was used in this study. The questions used in the interviews were based on a conceptual framework that applied certain constructs taken from Diffusion of Innovations Theory (DOI), Technology Acceptance Model (TAM) and e-Commerce’s Trustworthiness models. The research study results show that age, education, position within an organisation and the job that an individual is involved with inhibit or encourage the use and adoption of e-services. The contributions from this research are anticipated to be a better understanding of the diffusion, adoption and use of e-services in the UAE region. For industry the findings offer a diverse perspective as they provide some information on the impacts of e-services in public sector organisations of Abu Dhabi. Policymakers, particularly in the UAE and developing countries can learn of the impacts of e-government efforts in the public sector of Abu Dhabi.Final Published versio