A systems approach to healthcare: Agent-based modeling, community mental health, and population well-being
Authored by Gnana Bharathy, Barry G Silverman, Nancy Hanrahan, Kim Gordon, Dan Johnson
Date Published: 2015
DOI: 10.1016/j.artmed.2014.08.006
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Abstract
Purpose: Explore whether agent-based modeling and simulation can help
healthcare administrators discover interventions that increase
population wellness and quality of care while, simultaneously, decreasing costs. Since important dynamics often lie in the social
determinants outside the health facilities that provide services, this
study thus models the problem at three levels (individuals, organizations, and society).
Methods: The study explores the utility of translating an existing
(prize winning) software for modeling complex societal systems and
agent's daily life activities (like a Sim City style of software), into
a desired decision support system. A case study tests if the 3 levels of
system modeling approach is feasible, valid, and useful. The case study
involves an urban population with serious mental health and
Philadelphia's Medicaid population (n = 527,056), in particular.
Results: Section 3 explains the models using data from the case study
and thereby establishes feasibility of the approach for modeling a real
system. The models were trained and tuned using national epidemiologic
datasets and various domain expert inputs. To avoid co-mingling of
training and testing data, the simulations were then run and compared
(Section 4.1) to an analysis of 250,000 Philadelphia patient hospital
admissions for the year 2010 in terms of re-hospitalization rate, number
of doctor visits, and days in hospital. Based on the Student t-test, deviations between simulated vs. real world outcomes are not
statistically significant. Validity is thus established for the
2008-2010 timeframe. We computed models of various types of
interventions that were ineffective as well as 4 categories of
interventions (e.g., reduced per-nurse caseload, increased check-ins and
stays, etc.) that result in improvement in well-being and cost.
Conclusions: The 3 level approach appears to be useful to help health
administrators sort through system complexities to find effective
interventions at lower costs. (C) 2014 Elsevier B.V. All rights
reserved.
Tags
cognition
Illness
Comorbidity
Program