cesarean delivery model · natural childbirth types of childbirth delivery cesarean delivery...
TRANSCRIPT
![Page 1: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/1.jpg)
Cesarean Delivery ModelMeeting the challenge to reduce rates of Cesarean delivery
Alan Mills FSA MAAA NDNovember 13, 2014
![Page 2: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/2.jpg)
1. Background
2. The U.S. Cesarean delivery challenge
3. Cesarean Delivery Model design
4. Results
Agenda
![Page 3: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/3.jpg)
1. Background
![Page 4: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/4.jpg)
Vaginal deliverynatural childbirth
Types of childbirth delivery
Cesarean deliverysurgical intervention
![Page 5: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/5.jpg)
Cesarean delivery problems
Poor psychosocial outcomes Risks of major abdominal surgery Pulmonary disorders Compromised breast feeding Complications for later births Increased perinatal mortality Greater cost
![Page 6: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/6.jpg)
Netherlands (14%)
World cesarean delivery rates – 2008
Source: World Health Organization
![Page 7: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/7.jpg)
U.S. cesarean delivery rates – 2013
NJ
MA
WA
OR
CA
NV
AZ
UT CO
WY
MT
ID
ND
SD
NE
KS
OK
TX
AR
MO
IA
MN
WI
IL IN
KY
TN
MS
LA
AL GA
FL
SC
NC
VAWV
OH
MIPA
NY
ME
AK
HI
DE
MD
VTNH
CTRI
NM
35.1 – 46.0 30.1 – 35.0 25.1 – 30.0 20.1 – 25.0
Source:
Highest rate: 38.9%
Lowest rate: 22.4%
![Page 8: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/8.jpg)
U.S. cesarean delivery rates
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
2013:32.7%
1965:4.5%
Source:
![Page 9: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/9.jpg)
$- $5 $10 $15 $20 $25 $30 $35 $40 $45
Heart conditions
Normal birth/live born
Trauma-related disorders
Cancer
Osteoarthritis and other non-traumatic joint disorders
COPD, asthma
Gallbladder, pancreatic, and liver disease
Kidney Disease
Other CNS disorders
Systemic lupus and connective tissues disorders
U.S. hospital inpatient expenditures – 2011(ages 0 – 65, $ billions)
Source:
![Page 10: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/10.jpg)
2. The U.S. Cesarean delivery challenge
![Page 11: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/11.jpg)
How can we reduce the U.S Cesarean delivery rate
to a reasonable level (10% - 15%)?
![Page 12: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/12.jpg)
1. Focus on individual States
2. Bring together the State’s major stakeholders:LegislatorsHealth agenciesHealth insurersMedicaidClinicians (Obstetricians, Certified Nurse Midwives, Licensed Midwives)Women
3. Use AnyLogic simulations as the focus
My approach
![Page 13: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/13.jpg)
Reasons for using AnyLogic
One cogent framework accessible to all stakeholders: GIS visualization Sophisticated agent-based modeling Scalable for many agents State charts and flow diagrams for agent behavior Interface with Excel Robust experiment types Message passing
![Page 14: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/14.jpg)
Why agent based modeling?
Many heterogeneous agents interacting over time Independent agent behavior Importance of space Network effects Feedback
![Page 15: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/15.jpg)
3. Cesarean Delivery Model design
![Page 16: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/16.jpg)
Agents
Women Obstetricians Certified nurse midwives (CNMs) Licensed midwives (LMs) Hospitals Health insurers Medicaid
![Page 17: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/17.jpg)
Data
Data from the State:
Synthetic data Women Obstetricians, CNMs, LMs
Actual data Hospitals Insurers
![Page 18: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/18.jpg)
WomenChoose primary birth attendantRequest delivery attendance
ObstetriciansChoose HospitalDecide delivery methodSubmit claim
CNMsChoose HospitalChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
LMsChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
HospitalsSubmit claim
Insurers/MedicaidPay claim
Key behaviors
![Page 19: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/19.jpg)
WomenChoose primary birth attendantRequest delivery attendance
ObstetriciansChoose HospitalDecide delivery methodSubmit claim
CNMsChoose HospitalChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
LMsChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
HospitalsSubmit claim
Insurers/MedicaidPay claim
Key behaviors
![Page 20: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/20.jpg)
WomenChoose primary birth attendantRequest delivery attendance
ObstetriciansChoose HospitalDecide delivery methodSubmit claim
CNMsChoose HospitalChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
LMsChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
HospitalsSubmit claim
Insurers/MedicaidPay claim
Key behaviors
![Page 21: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/21.jpg)
WomenChoose primary birth attendantRequest delivery attendance
ObstetriciansChoose HospitalDecide delivery methodSubmit claim
CNMsChoose HospitalChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
LMsChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
HospitalsSubmit claim
Insurers/MedicaidPay claim
Messages
Key behaviors
![Page 22: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/22.jpg)
WomenChoose primary birth attendantRequest delivery attendance
ObstetriciansChoose HospitalDecide delivery methodSubmit claim
CNMsChoose HospitalChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
LMsChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
HospitalsSubmit claim
Insurers/MedicaidPay claim
Messages
Key behaviors
![Page 23: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/23.jpg)
WomenChoose primary birth attendantRequest delivery attendance
ObstetriciansChoose HospitalDecide delivery methodSubmit claim
CNMsChoose HospitalChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
LMsChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
HospitalsSubmit claim
Insurers/MedicaidPay claim
Messages
Key behaviors
![Page 24: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/24.jpg)
WomenChoose primary birth attendantRequest delivery attendance
ObstetriciansChoose HospitalDecide delivery methodSubmit claim
CNMsChoose HospitalChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
LMsChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
HospitalsSubmit claim
Insurers/MedicaidPay claim
Messages
Key behaviors
![Page 25: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/25.jpg)
WomenChoose primary birth attendantRequest delivery attendance
ObstetriciansChoose HospitalDecide delivery methodSubmit claim
CNMsChoose HospitalChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
LMsChoose backup ObstetricianRefer delivery attendanceAttend vaginal birthSubmit claim
HospitalsSubmit claim
Insurers/MedicaidPay claim
Messages
Key behaviors
![Page 26: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/26.jpg)
10. Outputmessages
1. Input messages
7. Context
8. Produceoutput
Agent
9. Sendoutput
3. Motivations 4. Attributes
6. Rules5. Experience
2. Getinput
General behavior model
![Page 27: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/27.jpg)
Example behavior:Choose primary birth attendant
Agent: Woman1. Input messages: Childbirth month (data item)2. Get input: NA3. Motivations: Desired birth attendant type (data item)4. Attributes: Residence latitude and longitude (data item)5. Experience: NA6. Rules: NA7. Context: NA8. Produce output: Get Identifier of nearest desired birth attendant type9. Send output: Send output to Woman attributes10.Output messages: Clinician Identifier
![Page 28: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/28.jpg)
10. Outputmessages1. Input
messages
8. Produceoutput
Agent
9. Sendoutput
3. Motivations 4. Attributes
Example behavior:Choose primary birth attendant
![Page 29: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/29.jpg)
“Message” Class parameters: Message type Sending agent type Sending agent identifier Woman identifier Delivery method Amount
Messages are passed using “send(Object, Agent)”through AnyLogic’s standard “connections” link.
Message passing
![Page 30: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/30.jpg)
Environment (GIS)
Visualization
HospitalsWomen
Obstetricians
Certified Nurse Midwives(CNMs)
Licensed Midwives(LMs)
Insurers
![Page 31: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/31.jpg)
Visualization: Washington State
![Page 32: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/32.jpg)
Model demonstration: Visualization
![Page 33: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/33.jpg)
User interface
![Page 34: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/34.jpg)
Model demonstration: User interface
![Page 35: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/35.jpg)
4. Results
![Page 36: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/36.jpg)
Significance of the Cesarean Delivery Model
First holistic model of the Cesarean delivery challenge Stakeholder focus for Cesarean delivery reform First step toward a complete health system model First step toward reusable agents and behaviors
![Page 37: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/37.jpg)
Model demonstration: Results
![Page 38: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/38.jpg)
Key results
Payment reform by itself won’t work as intended A multi-faceted approach is required Retooling the workforce will take time
![Page 39: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/39.jpg)
Questions or comments?
![Page 40: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/40.jpg)
1. Background
2. The U.S. Cesarean delivery challenge
3. Cesarean Delivery Model design
4. Results
Review
![Page 42: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/42.jpg)
Thank you
![Page 43: Cesarean Delivery Model · natural childbirth Types of childbirth delivery Cesarean delivery surgical intervention. Cesarean delivery problems Poor psychosocial outcomes Risks of](https://reader030.vdocuments.net/reader030/viewer/2022041100/5ed77434c58fb52733203788/html5/thumbnails/43.jpg)