Planning for resilience in screening operations using discrete event simulation modeling: example of HPV testing in Peru.
Planning for resilience in screening operations using discrete event simulation modeling: example of HPV testing in Peru.
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DOI：
10.1186/s43058-022-00302-5
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发表时间：
2022-06-17
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世界卫生组织(WHO)呼吁根除宫颈癌。不幸的是，实施具有成本效益的预防和控制战略面临重大障碍，例如对资源和行动规划的最佳做法指导不足。因此，我们展示了离散事件模拟(DES)在实施科学研究和实践中的价值，特别是在支持可持续和有弹性地提供医疗干预措施的计划和操作规划方面。我们的具体例子展示了DES模型如何为秘鲁亚马逊城市伊基托斯新的基于HPV的筛查和治疗项目的扩大和弹性运营规划提供信息。使用来自秘鲁伊基托斯的时间和运动研究以及宫颈癌筛查登记的数据，我们开发了一个DES模型，以进行虚拟实验，在资源限制和筛查系统中断的情况下，比较不同的工作流程和处理策略。我们的模拟表明，在当前资源水平下，筛查系统的容量可以增加多少，服务时间的可变性可以容忍多少，以及对中断的恢复能力，如资源减少的程度。这些模拟还确定了扩大规模以满足更大目标人群或提高对中断的弹性所需的资源，说明了弹性和效率之间的关键权衡。因此，我们的结果展示了DES模型如何为特定的资源分配决策提供信息，但也可以突出重要的权衡，并为资源和运营规划提出一般的“规则”。多层次的规划和实施挑战并不是可持续采用宫颈癌筛查计划所独有的，而是在全球范围内成功扩大许多预防性卫生干预措施的共同障碍。DES是一种广泛适用的工具，可以应对在国家、地区和地方各级确定的跨环境和卫生干预措施的复杂实施挑战-如何做出有效和高效的运营和资源决策，以支持项目适应当地的限制和需求，以便它们能够适应不断变化的需求，并更有可能随着时间的推移保持忠诚。
The World Health Organization (WHO) has called for the elimination of cervical cancer. Unfortunately, the implementation of cost-effective prevention and control strategies has faced significant barriers, such as insufficient guidance on best practices for resource and operations planning. Therefore, we demonstrate the value of discrete event simulation (DES) in implementation science research and practice, particularly to support the programmatic and operational planning for sustainable and resilient delivery of healthcare interventions. Our specific example shows how DES models can inform planning for scale-up and resilient operations of a new HPV-based screen and treat program in Iquitos, an Amazonian city of Peru. Using data from a time and motion study and cervical cancer screening registry from Iquitos, Peru, we developed a DES model to conduct virtual experimentation with “what-if” scenarios that compare different workflow and processing strategies under resource constraints and disruptions to the screening system. Our simulations show how much the screening system’s capacity can be increased at current resource levels, how much variability in service times can be tolerated, and the extent of resilience to disruptions such as curtailed resources. The simulations also identify the resources that would be required to scale up for larger target populations or increased resilience to disruptions, illustrating the key tradeoff between resilience and efficiency. Thus, our results demonstrate how DES models can inform specific resourcing decisions but can also highlight important tradeoffs and suggest general “rules” for resource and operational planning. Multilevel planning and implementation challenges are not unique to sustainable adoption of cervical cancer screening programs but represent common barriers to the successful scale-up of many preventative health interventions worldwide. DES represents a broadly applicable tool to address complex implementation challenges identified at the national, regional, and local levels across settings and health interventions—how to make effective and efficient operational and resourcing decisions to support program adaptation to local constraints and demands so that they are resilient to changing demands and more likely to be maintained with fidelity over time.
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作者：
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DOI：
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发表时间：
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影响因子：
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