Modeling U.S. Health Systems' Epidemic Response Capacity

描述（由申请人提供）： 该提案的目标是利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应急反应的能力。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善应对策略，生物恐怖主义相关）和人类疾病的自然爆发（即，流行病）。最终，这项研究将使更多的循证政策分析和决策的公共卫生准备和医院激增能力的资源分配。 能力评估将通过开发医院治疗六种A类生物恐怖分子制剂和严重急性呼吸系统综合症的离散事件模拟模型来完成。这些模型将根据反映疾病和公共卫生反应变量（例如，暴发类型和规模、初始大规模预防反应的有效性）。这项研究通过估计这些生物剂爆发的区域能力，将提供国家公共卫生准备工作的新情况。 该项目的第二个组成部分将评价在公共卫生紧急情况下利用紧急卫生服务的模式。将利用来自纽约长老会医疗保健系统的管理数据，对2001年炭疽袭击期间纽约市八个急诊部门的病人“激增”进行评估。这项研究将补充国家级医院的能力评估，通过评估邻里的病人到达的变化，因为公众对这种灾难的反应有重要意义的大规模预防规划。 总之，这些研究将促进公共卫生防备科学，并提供工具，以改善对卫生系统能力的预测和规划有效的流行病应对措施。

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.