Modeling U.S. Health Systems' Epidemic Response Capacity

描述(由申请人提供)：本提案的目标是使用先进的计算机建模技术评估美国医院应对生物恐怖主义和公共卫生紧急情况的能力。这项工作将促进对卫生系统应对医疗危机的科学理解，并创建决策工具，帮助医院和公共卫生规划者改进应对人类疾病故意(即与生物恐怖主义有关)和自然爆发(即流行病)的战略。最终，这项研究将允许对公共卫生准备和医院激增能力的资源分配进行更多基于证据的政策分析和决策。 能力评估将通过为六种A类生物恐怖分子和严重急性呼吸系统综合症开发医院治疗的离散事件模拟模型来完成。这些模型将在313个美国医院转诊地区中的每个地区的医院床位容量与反映疾病和公共卫生反应变量(例如，疫情类型和规模、初始大规模预防反应的有效性)的模拟流行曲线之间进行平衡。通过评估这些生物制剂暴发的区域能力，这项研究将为国家公共卫生准备工作提供一幅新的图景。 该项目的第二个组成部分将评估突发公共卫生事件背景下的应急卫生服务利用模式。在2001年的炭疽病袭击期间，将使用纽约长老会医疗保健系统的管理数据来评估纽约市八个急诊科的患者“激增”。这项研究将通过评估逐个社区的病人到达情况的差异来补充国家级医院能力评估，因为公众对此类灾难的反应对大规模预防规划具有重要影响。 综上所述，这些研究将推进公共卫生准备的科学，并提供工具来改进对卫生系统能力的预测和规划有效的流行病应对。

DESCRIPTION (PROVIDED BY APPLICANT): The goal of this proposal is to assess U.S. hospital capacity for bioterrorism and public health emergency response using advanced computer modeling techniques. This work will advance the scientific understanding of health system responses to medical crises, and create decision making tools that will help hospital and public health planners improve response strategies for both intentional (i.e., bioterrorism-related) and natural outbreaks of human disease (i.e., epidemics). Ultimately this research will permit more evidence-based policy analysis and decision-making regarding resource allocation for public health preparedness and hospital surge capacity. Capacity assessment will be accomplished by developing discrete event simulation models of hospital treatment for the six Category A bioterrorist agents and for Severe Acute Respiratory Syndrome. These models will balance hospital bed capacity in each of the 313 U.S. Hospital Referral Regions against simulated epidemic curves that reflect both disease and public health response variables (e.g., outbreak type and size, effectiveness of initial mass prophylaxis response). By estimating regional capacity for outbreaks of these biological agents, this study will offer a new picture of national public health preparedness. A second component of this project will evaluate patterns of emergency health service utilization in the setting of public health emergencies. Patient "surges" at eight New York City emergency departments will be evaluated during the 2001 anthrax attacks using administrative data from the New York Presbyterian Healthcare System. This study will complement the national-level hospital capacity assessment by evaluating neighborhood-by-neighborhood variability in patient arrivals, since the response of the public to such disasters has important implications for mass prophylaxis planning. Taken together, these studies will advance the science of public health preparedness and provide tools to improve forecasting of health system capacity and for planning an efficient epidemic response.