Designing Care Pathways Using Simulation Modeling and Machine Learning
- 1. Winter Simulation Conference 2018 Designing Care Pathways Using Simulation Modeling and Machine Learning Mahmoud Elbattah, Owen Molloy, Bernard P. Zeigler mahmoud.elbattah@nuigalway.ie https://ieeexplore.ieee.org/document/8632360
- 2. Winter Simulation Conference 2018 MainPoints • Background: Value-based Care Delivery (Porter’s Strategy) • A Framework for M&S of Value-based Health System • Use Case: Pathways Coordination for Hip Fracture Care in Ireland
- 3. WSC 2018 Background: Value-Based Care Delivery (Porter’s Strategy)
- 4. Winter Simulation Conference 2018 Key IssuesaroundHealthcareDelivery • Universal Coverage: Essentially required to support fundamental reorientation of the delivery system around value. • Cost Containment: Financial success for healthcare providers does NOT necessarily mean success for patients. • Value of Care : Usually ill-defined, though it has to be the core issue. Value: Outcome per unit cost at the output of the end-to-end care delivery value chain (CDVC). (Michael Porter 2006) Porter, M.E. and Teisberg, E.O., 2006. Redefining health care: creating value-based competition on results. Harvard Business Press.
- 5. Principles of Value-Based Healthcare Delivery (MichaelPorter2006) • Prevention of illness • Early Detection • Right diagnosis • Right treatment to the right patient • Early and timely treatment • Rapid cycle time of diagnosis and treatment • Fewer complications • Fewer mistakes and repeats in treatment. • Faster recovery • More complete recovery • Less disability • Fewer recurrences Porter, M.E. and Teisberg, E.O., 2006. Redefining health care: creating value-based competition on results. Harvard Business Press. Better health is the goal, NOT more treatment.
- 6. Winter Simulation Conference 2018 Key Questions • How to design a healthcare system that can improve patient value? • How to engineer a dynamic system for healthcare delivery that can sustainably improve patient value?
- 7. Winter Simulation Conference 2018 A StrategicAgendafor Value-BasedHealthcare (MichaelPorter2013) 1. Organize into Integrated Practice Units (IPUs) 2. Measure Outcomes and Costs for Every Patient 3. Move to Bundled Payments for Care Cycles 4. Integrate Care Delivery Systems 5. Expand Geographic Reach 6. Build an Enabling Information Technology Platform Porter, M.E. and Lee, T.H., 2013. The strategy that will fix health care. Harv Bus Rev, 91(12), p.24.
- 8. Winter Simulation Conference 2018 Our Objective • Formalize Porter’s IPU with System-of-Systems Modeling and Simulation • Formulate criteria for creation of IPUs viewed as systems • Many questions, e.g., can a collection of systems with their care delivery value chain be integrated into a viable system?
- 9. WSC 2018 A Frameworkfor M&S of Value-based Health System
- 10. Winter Simulation Conference 2018 M&SFrameworkof Value-BasedHealth System Coordination Of Care Patient Health Care System Patient with Improved condition Patient with medical problem Clinical Domain Extra- Clinical Domain Coordination Cost Increased Value = Outcome/cost Improvement in Outcome 1. Generate target population of appropriate physical, behavioural and socioeconomic characteristics. 2. Track patients through system with and without coordination of care. 3. Evaluate cost of coordination as addition to total cost. 4. Evaluate improvement in outcome and effect on cost. 5. Compute Return on Investment (ROI) = Cost saving per dollar of coordination cost. Zeigler, B.P., 2016. “Discrete Event System Specification Framework for Self-Improving Healthcare Service Systems”. IEEE Systems Journal (99):1-12.
- 11. Winter Simulation Conference 2018 11 Pathways-Based Coordination for VBHS Components ServicesLegend: Clinical Domain Extra- Clinical Domain Diagnostic Services Treatment Services Recovery Services Follow- up Services Integrated Practice Unit (IPU) - clinical Physicians Observation & Analysis Labs Hospitals Coordination Services Assisted Self- Management Services Community Team Care– extra clinical Pathw ays Based Coordination Care Agencies Care Coordinators Hierarchical Composition M&SFrameworkof Value-BasedHealth System(cont’d)
- 12. Winter Simulation Conference 2018 The Role of MachineLearning: IncrementalLearningfrom Data 12
- 13. WSC 2018 Use Case: PathwaysCoordinationfor Hip FractureCare in Ireland
- 14. Winter Simulation Conference 2018 Our Focus: Hip FractureCare in Ireland • A good exemplar of elderly healthcare. • Exponentially increasing with age.1 • Identified as one of the most serious injuries resulting in lengthy hospital admissions and high costs.2 • Availability of empirical data from the Irish Hip Fracture Database (IHFD). 14 1 Gullberg, B., Johnell, O. and Kanis, J.A., 1997. World-wide projections for hip fracture. Osteoporosis international, 7(5), pp.407-413. 2http://www.hse.ie/eng/services/publications/olderpeople/Executive_Summary_Strategy_to_Prevent_Falls_and_Fractures_in_Ireland%E2%80%99s_Ageing_Population.pdf
- 15. Winter Simulation Conference 2018 Sourcesof Data • Irish Hip Fracture Database (IHFD) (2013-2015). • Population projections from the Central Statistics Office (CSO). • Additional population statistics from the Health Intelligence Department. 15
- 16. Winter Simulation Conference 2018 Learning Patient Clustersfrom Data 16 Visualisation of K-Means clustering with K ranging from 2 to 5. Clustering of patients based on: • LOS • Age • Time to Surgery
- 17. Winter Simulation Conference 2018 Insightsfrom Clusters 17
- 18. Winter Simulation Conference 2018 ReflectingData-DrivenInsightson ModelDesign 18
- 19. Winter Simulation Conference 2018 Modeling Care Coordination 19
- 20. Winter Simulation Conference 2018 Summary • Health Care Reform is usefully viewed as a Systems Problem. • Porter’s Value-based Health care within a more inclusive Pathways Coordinated Care framework provides needed coordination. • The proposed framework incorporates M&S with ML for designing pathways and evaluating the ROI of implementation. • ML can generally be utilised as an assistive artefact within the process of conceptual modeling.
- 21. Winter Simulation Conference 2018 Publications • Zeigler,B. P., E. L. Carter, O. Molloy, and M. Elbattah. 2016.“Using Simulation Modeling to Design Value-Based Healthcare Systems”. In Proceedingsof the Operational ResearchSocietyAnnual Conference (OR58),6th -8th September,Portsmouth,England. • Zeigler,B P., (2016)“Discrete Event System SpecificationFramework for Self-Improving Healthcare Service Systems,” IEEESystems Jnl. Volume:PP Issue:99 • Zeigler,B P.; Ernest L., et al. (2016)"Guiding Principles forData Architecture to Supportthe Pathways Community HUB Model," eGEMs , http://repository.edm-forum.org/egems/vol4/iss1/1 • Zeigler,B P.; Ernest L., et al. (2014)“CommunityHUB Pathways: A Modelfor Coordination of Community Health Care,” Population Health Management, vol. 17, no. 4, pp. 199-201. • Zeigler,B P.; Ernest L., et al. (2014),Care Coordination: Formalization of Pathways forStandardization and Certification, • Innovations Exchange Team, B.P., Zeigler,S. A. Redding.Formalization of the Pathways Model Facilitates Standards and Certification. • Zeigler,B P.; Ernest L., et al. (2012)“Methodologyand Modeling Environment for Simulating National Health Care” 2012 Autumn Simulation Multi-Conference (AutumnSim'12)October28-31,San Diego,CA.. Value-based Learning Healthcare Systems: Integrative modeling and simulation (Healthcare Technologies) by Bernard P. Zeigler, Mamadou K. Traore, Grégory Zacharewicz, Raphaël Duboz The Institution of Engineering and Technology(January 10, 2019)
- 22. Winter Simulation Conference 2018 THANK YOU! mahmoud.elbattah@nuigalway.ie