Models For Designing Evidence-Based Patient-Centered Health Care Systems

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The research objective of this award is to develop models that increase our understanding of complex health care delivery systems from the perspective of the patient flowing through the system. The project will i) create a care delivery reference model, that will explain the interactions and inter-dependencies of the many functions, process flows, behaviors, constraints, and attributes of current U.S. health care delivery systems; and ii) using the reference model as a guide, construct a suite of operational systems engineering models to examine the complex interactions between patients, sources of primary and secondary care, facilities, insurance providers, laboratories, pharmacies, and other ancillary services. The approach will include simulation, Markov chain models, stochastic optimization, and simulation optimization. These models will help compare the performance of design alternatives and their impact on patient-centered care in modern health care delivery systems. The modeling effort will relate patient needs with resources and clinical outcomes to guide design of primary care based health care delivery systems. The models developed will be used to investigate: the Patient Centered Medical Home, which will examine how to reorganize the clinic workforce to match patients with care provider teams in an optimal manner; Accountable Care Organizations, which will investigate when to contract outside specialists to optimize the flow of patients with regards to clinical effectiveness and financial factors; and Redesign of Outpatient Health Care Facilities, which will analyze the performance of new patient-centered arrangements where services are brought to the patient's physical location. The impact of virtual interaction between patients and providers including video, email, and phone communication will also be evaluated. This research will make a broad impact on national health care, by creating a consistent and comprehensive basis for evaluating alternative designs of patient-centered health care delivery systems.