Is it beneficial to increase the provision of thrombolysis?- a discrete-event simulation model
Is it beneficial to increase the provision of thrombolysis?- a discrete-event simulation model
复制标题
DOI：
10.1093/qjmed/hcs036
复制
发表时间：
2012-07-01
影响因子：
13.3
通讯作者：
Fullerton, K.
中科院分区：
文献类型：
--
作者：
Barton, M.;McClean, S.;Fullerton, K.
目的：我们考虑投资溶栓对重要急性卒中服务的影响，以及对生活质量的影响。这个概念是说明使用数据从北方爱尔兰中风Service.Design：回顾性study.Methods：我们首先提出的生存分析结果，利用住院时间（LOS）的放电目的地，从贝尔法斯特市医院（BCH）的数据为基础。这些患者实际上都没有接受溶栓治疗，但从那些符合条件的患者中，我们创建了两个初始组，第一组代表接受溶栓治疗的患者，第二组包括未接受溶栓治疗的患者。在生存分析的基础上，我们根据出院目的地创建了几个亚组。然后，我们开发了一个离散事件模拟（DES）模型，其中每个组是模拟中的一个患者通路。Coxian相位类型分布被用来模拟组LOS。探讨了各种方案，重点是对这些患者进行溶栓治疗的医院、社区和社会服务的成本效益，以及增加溶栓治疗患者比例可能改善的生活质量。我们模拟这一历史组患者的各种情景的目的是评估在不同情景下溶栓的成本效益;从这一点我们可以推断未来政策的可能成本效益。结果：溶栓的成本被医院、社区康复和机构护理成本的减少所抵消，生活质量也相应改善。结论：我们的模型表明，提供溶栓将产生温和的整体改善服务，假设目前的资金水平。
Aim: We consider the impact of investing the impact of thrombolysis on important acute stroke services, and the effect on quality of life. The concept is illustrated using data from the Northern Ireland Stroke Service.Design: Retrospective study.Methods: We first present results of survival analysis utilizing length of stay (LOS) for discharge destinations, based on data from the Belfast City Hospital (BCH). None of these patients actually received thrombolysis but from those who would have been eligible, we created two initial groups, the first representing a scenario where they received thrombolysis and the second comprising those who do not receive thrombolysis. On the basis of the survival analysis, we created several subgroups based on discharge destination. We then developed a discrete event simulation (DES) model, where each group is a patient pathway within the simulation. Coxian phase type distributions were used to model the group LOS. Various scenarios were explored focusing on cost-effectiveness across hospital, community and social services had thrombolysis been administered to these patients, and the possible improvement in quality of life, should the proportion of patients who are administered thrombolysis be increased. Our aim in simulating various scenarios for this historical group of patients is to assess what the cost-effectiveness of thrombolysis would have been under different scenarios; from this we can infer the likely cost-effectiveness of future policies.Results: The cost of thrombolysis is offset by reduction in hospital, community rehabilitation and institutional care costs, with a corresponding improvement in quality of life.Conclusion: Our model suggests that provision of thrombolysis would produce moderate overall improvement to the service assuming current levels of funding.