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

该奖项的研究目标是开发模型，从患者流经系统的角度增加我们对复杂医疗保健提供系统的理解。该项目将i)创建一个医疗服务参考模型，该模型将解释当前美国医疗服务系统的许多功能、流程流、行为、约束和属性之间的相互作用和相互依赖关系；ii)以参考模型为指导，构建一套操作系统工程模型，以检查患者、初级和二级保健来源、设施、保险提供商、实验室、药房和其他辅助服务之间的复杂相互作用。该方法将包括模拟、马尔可夫链模型、随机优化和模拟优化。这些模型将有助于比较设计方案的性能及其对现代卫生保健提供系统中以患者为中心的护理的影响。建模工作将患者需求与资源和临床结果联系起来，以指导基于初级保健的卫生保健提供系统的设计。开发的模型将用于调查：以患者为中心的医疗之家，它将研究如何重组诊所劳动力，以最佳方式将患者与护理提供者团队相匹配；问责医疗组织（Accountable Care Organizations）将调查何时与外部专家签约，以优化临床疗效和财务因素方面的患者流量；门诊医疗设施的重新设计，这将分析新的以病人为中心的安排的表现，在这种安排中，服务被带到病人的实际位置。还将评估患者和提供者之间的虚拟互动的影响，包括视频，电子邮件和电话交流。这项研究将对国家卫生保健产生广泛的影响，为评估以患者为中心的卫生保健提供系统的替代设计创造一致和全面的基础。

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.