An Investigation into Operations Research (OR) Methods for the Demand and Supply-side Modelling of Donor Human Milk Banks

最近，苏格兰(NHS苏格兰，2016)、威尔士(亚的斯亚贝巴，2018)和英格兰(NHS England，2017)的国家倡议强调联合制作，“确保有生活经验的人的声音被纳入决策，从委托到联合设计和联合交付”(McNally，2016)，将“不仅有时，而且一直”嵌入服务提供。据报道，联合制作改善了服务提供，减少了疾病负担，改善了治疗，降低了成本(例如，肿瘤学(Basch，等人，2017)和风湿病(Essen&Lindbland，2013))。联合制作与以下拟议的项目目标相关。文献空白和研究问题尽管pDHM的使用带来了健康益处和长期的经济节省，但美国国家卫生与护理卓越研究所(NICE，2010)并未就pDHM的临床使用提出建议。巴特斯比等人。(2018)强调2012-13年间在英格兰NICU中pDHM的使用不统一。否则，在以下方面的文献中找不到任何信息：国民保健服务信托基金/医院之间提供保健保健服务的政策差异；利益攸关方参与(共同制作)确定政策；捐助者的特点；英国实际或可实现的捐赠量；保健服务提供与随后的捐赠率之间的任何联系。此外，尚未发现有关英国母乳银行运作(包括供需双方)或稳健性(例如污染事件或设备故障)的任何方面的信息。鉴于上述高级别研究问题，以及相关的相关目标，如下：问题1。在英国，母乳捐赠、母乳银行和医院使用的全周期有什么特点，包括政策制定和公众参与？目标：了解捐赠者、母乳银行、信托/医院、接受者之间的关系结构，包括利益相关者在整个NHS信托基金中参与政策制定的程度。了解NHS信托基金之间的政策差异，以及利益相关者参与pDHM政策制定目标：评估是否存在增加联合生产的空间，如果存在，其潜在利益问题-2政策和公众态度的变化可能如何影响供需和受援家庭的生活质量？目的：了解供者供方(对母乳银行)的特征，并确定捐赠率与pDHM供应之间的相关性。目的：建立供者供方约束与潜在增加需求的问题-3。英国的母乳银行系统在运作上是否高效和稳健？目标：建立一个利益相关者参与的模型，允许探索英国母乳银行的运营方面和稳健性。

Recently, national initiatives in Scotland (NHS Scotland, 2016), Wales (Addis, et al., 2018) and England (NHS England, 2017), have emphasised co-production, "ensuring that the voices of people with lived experience are included in decision-making, from commissioning to co-design and co-delivery" (McNally, 2016), to be embedded "not just sometimes but all the time" in service provision. Reportedly, coproduction has led to improvements to service provision, with reduced burden of illness, improved treatment, and reduced costs (e.g. in oncology (Basch, et al., 2017) and rheumatology (Essen & Lindbland, 2013)). Co-production is relevant to the proposed project objectives below. Literature Gaps and Research Questions Despite the health benefits and long-term financial savings associated with pDHM use, the National Institute for Health and Care Excellence (NICE, 2010) provides no recommendations on clinical usage of pDHM. Battersby et al. (2018) highlights non-uniform use of pDHM across NICUs in England in 2012-13. Otherwise no information has been found in the literature on: policy variations for pDHM provision between NHS Trusts/hospitals; stakeholder engagement (co-production) in determining policies; characteristics of donors; actual or achievable donation volumes in the UK, or any links between pDHM provision and subsequent donation rates. Furthermore, no information has been found on any aspect of operations (including supply and demand sides) or robustness (for instance contamination events or equipment failures) of milk banking in the UK. Given the above, high-level research questions, and associated linked objectives, follow: Question-1. What are the characteristics of the full-cycle of human milk donation, milk banking, and hospital use, in the UK, including policy-setting and public engagement? Objective: Understand structures of relationships between donors, milk banks, Trusts/hospitals, recipients, including degree of stakeholder involvement in policy-setting, across NHS Trusts. Understand policy variations between NHS Trusts and if any observable benefits due to stakeholder participation in pDHM policy-setting Objective: Assess if scope to increase co-production exists, and if so its potential benefits Question-2 How might changes in policy and public attitudes influence supply and demand and the quality of life of recipient families? Objective: Understand characteristics of donor supply-side (to milk banks) and determine the correlation between donation rates and pDHM provision Objective: Establish the donor supply-side constraints vs. potential increased demand Question-3. Is the milk banking system in the UK operationally efficient and robust? Objective: Build a model with stakeholder engagement, allowing exploration of the operational aspects and robustness of milk banking in the UK.