online workshop: improving patient care pathways

Improving Patient Care Pathways

Claire Cordeaux: Executive Director, Healthcare

SIMUL8 Corporation | SIMUL8.com | [email protected]

Presenter

Claire Cordeaux

Executive Director, Healthcare SIMUL8 SIMUL8 Corporation

[email protected]

mailto:[email protected]



• Understanding patient care through pathways• How simulation can help• Examples• Standard of Care• Sharing across a community• How you can get involved

Agenda

Patient Care Pathways

Routinely used to understand and improve practice• Services • Clinical practice• Disease

Patient Care Pathways: Services

Process flow through services

Patient Care Pathways: Clinical Practice

Used to show best clinical practice.

Map of Medicine

Patient Care Pathways: Disease Progression

Show progression through disease states over time.

Our Approach to Simulating Pathways

Combining disease state transitions with best practice and service access.

Why?• Test impact of service redesign on disease

progression• Genericized – can be used and localised by any

group interested improving pathways for patients with the same condition


Disease Transitions: State Charts

• Define all disease states patients can transition to.

• Input the transitions between states. (Rates, %, Time)

• As simulation runs patients will transition to an from states based on the inputted rules.


Service Model

The disease transition model is linked to a service or treatment model.

As patients transition into different states they use different service. They trigger events in a DES model.


Best Clinical Practice

New interventions, best clinical practice, service redesign can all be tested for impact on:

Cost, Resource, Activity, Waiting times

AND

Disease Progression


Case Study 1: HIV

What is the impact of screening?

What is the impact of increasing frequency of attendance to improve adherence?

• on future burden of disease • projected treatment costs for the service


Age-banded population projections

Age-banded disease

prevalenceDemand

1.23m x HIV 0.465% = 2531

Simulating Demand


Simulated Demand: Catchment Population

The projected population is decreasing


25% of patients are undiagnosed and use this pathway.

Undiagnosed patients can infect others.

Late diagnosis leads to becoming symptomatic and very sick.

Diagnosis (Current State)


Diagnosis (Current State)

Successful ART leads to near normal life expectancy

Cost per year if symptomatic and AIDs

75% of patients are diagnosed and use this pathway.

Diagnosed but untreated can infect others

Late diagnosis leads to becoming symptomatic and very sick


Costs (indicative only)

Cost $Diagnosis 100Follow up Appointment and Drug therapy every 6 months

9,000

HIV symptoms (annual) 25,000AIDS (1 year only) 50,000


Activity Results

These results represent no change for next 5 years.

1 2 3 4 50

2000

4000

6000

8000

10000

12000

14000

new infectionsARTFollow ups


What if screening reduces undiagnosed to 15%?

Costs decrease over time as fewer patients develop HIV Symptoms and Aids and fewer are infected, although follow ups increase.

1 2 3 4 50

50000000

100000000

150000000

200000000

250000000

Screening CostsCosts

1 2 3 4 50

500

1000

1500

2000

2500

Screening AidsAidsScreening HIV SymptHIV sympt

1 2 3 4 50

2000

4000

6000

8000

10000

12000

14000

Follow upsScreeningFollow ups

Scenario 1 Results


What if we see patients every 3 instead of very 6 months and this increases successful ART?

Scenario 2


Scenario Results: Increasing Treatment Frequency

Costs increase but infections reduce. Symptomatic patients reduce in years 4 and 5

1 2 3 4 50

50000000

100000000

150000000

200000000

250000000

Screening CostsCostsSupported ART Costs

1 2 3 4 50

50

100

150

200

250

New infection baselineNew Infection ScreeningNew infection Supported ART

1 2 3 4 50

500

1000

1500

2000

2500

Baseline HIV symptScreening HIV SymptSupport ART HIV Sympt


What Resources are Required?

1 2 3 4 50

2000

4000

6000

8000

10000

12000

14000

16000

Baseline follow upsSreening Follow upsSupport ART Follow ups

Follow ups increase in each scenario – with 100 weekly appointments wait times are unacceptable.


Resource requirements

Increasing weekly appointments to 250 brings wait times in line with requirements


Case Study 2: Dementia


Results after multiple runs


Template Simulations

What are the key features of any disease pathway?

Share your thoughts via our survey monkey and we will report back.


Standard of Care

Imagine a simulated pathway including:• Expected demand from population health predictions and

disease progression• Evidence-based best clinical practice• Localizable to individual providers and populations

Answering questions:• What if I implement best practice?• What will this look like in 3-5 years time?• What resources will I need?• How much will it cost/what income will I earn?• Will I have patients waiting if I don’t increase staffing?• What will patient outcomes be?


Share and Manage Pathways on the Web

Have multiple user logins to access a suite of simulation models.


Create Simulation Suites

Upload multiple models which user can run, change, SAVE and EXPORT results from. These users can also share these with others.


Manage Access

Create localized simulations and assign them so that only specific users can view particular simulations.


Do Once and Share

Our offer to you

Help us build pathways we can share.

Send us your pathway suggestions and we will choose one to build and share using our new technology

Email to [email protected]


QUESTIONS

Please forward any topics you would like to see covered to [email protected]

Continue the discussion on SIMUL8 in Health – LinkedIn Group

September Workshop – “Optimizing Outpatient Operations – Staffing & Scheduling”.


online workshop: improving patient care pathways

Healthcare

late diagnosis leads

patient care pathways

current state

clinical practice

simul8 corporation

info simul8

service redesign

diagnosis