The research objective of this award is to develop a general modeling framework for national health care that will enable simulations to study specific approaches to improve care while reducing cost. For example, simulations will allow Accountable Care Organizations (ACOs) to study specific coordinated care systems to fill the gap between hospital and doctor aimed at reducing re-admissions and medication errors. ACOs will also be able to examine the tradeoff between quality and cost of such coordinated care. A range of simulation tools will be developed to support the design of coordination architectures and predict important quality metrics that are applicable to diverse populations. The modeling approach will integrate mathematical system and agent modeling concepts extended to include human behavioral limitations. The overall model will significantly extend an established coordinated care framework and will be validated against data obtained from a successful program for women with high risk pregnancies.
The results of this research will show how to systematically model the behaviors of patients who require coordinated care interventions, thus rendering these behaviors amenable to health care system design and engineering. The systems-level simulation models will identify the various community partners and how they can be effectively coordinated using emerging health information networks and electronic medical records. Beyond impacting health care, the new methodology for system-level modeling and simulation will support constructing and testing alternative architectures for coordinating component systems prior to implementation in diverse societal sectors such as engineering, defense, and agriculture. The tool set employed to build the models will be widely distributed through the proposer?s software distribution services. The model library will be promulgated by a collaborating coordinated care institute to a wide network of organizations set up to provide such care.
A workshop on "Industrial and Systems Engineering and Healthcare: Critical Areas", held in 2009 was co-sponsored by the NSF and the Agency for Healthcare Research and Quality. It envisioned an ideal health care system that is unlike today’s fragmented, loosely coupled, and uncoordinated assemblage of component systems. The workshop concluded that, "An ideal (optimal) health care delivery system will require methods to model large scale distributed complex systems." Our research objective was to develop such methods. As illustrated in the Figure (Care Coordination Model), we visualize an "as is" health care system in which a patient is treated for a medical problem and emerges with a, hopefully, improved condition. Coordination is shown as an additional component that identifies the various community partners involved in health care and rigorously lays out how their interactions are more effectively coordinated to improve the care that a patient receives and consequently, the quality of the outcome. The most cost effective care aims to treat the neediest patients that cost the most. The criteria for such a model are that it should be: Flexible to meet variety of stakeholders’ interests and variety of accountable care implementations. Scalable to accommodate increases in scope, resolution and detail. Integrate system of system concepts – system, components, and agent concepts extended to human behavioral limitations. Enhance Electronic Medical Records and Health Information Technology systems as needed to support coordinated care. Support services based on model, e.g., patient tracking, medication reconciliation, etc. The Pathways Community HUB Model is a model of care coordination that was developed by the Ohio Community Health Access Project (CHAP) in Richland County to improve health and preventative care for high-risk mothers and children in difficult-to-serve areas. In order to focus model development and to enable data access for calibration and validation, CHAP agreed to work with us as the test bed for our model development. In this regard, CHAP agreed to provide access, under suitable data sharing agreements, to its data base of client and pathway records. This provided an instance of the Pathways Community Care Coordination framework as a basis for our systems-level simulation model. In the initial phase, our objective was to construct and validate the model when applied to high-risk mothers and children in difficult-to-serve areas following the CHAP coordinated care pathways for the case of successful normal birth outcomes. We collected de-identified personal health and behavioral data (such as demographic, socio-economic, etc.) for successfully and unsuccessfully treated clients from the EMR data base employed by CHAP. As with earlier studies, we encountered data quality problems. Overcoming these issues lead us to development of specific metrics and tools to assess data quality and maximize its usefulness. Consulting with the CHAP participants in the project, it became apparent that the metrics and tools developed would be useful to implementations of the Pathways model independently of their use in our data analysis. We also realized that these tools would enable us to compare output of the model to be developed with actual CHAP data at a more in-depth level and more extensively than initially contemplated. Intellectual Merit: We achieved major advances toward developing a general modeling framework for national health care that will enable a suite of simulations to study specific approaches to improve care while reducing cost. We have focused on coordinated care with the goal of enabling design and development of architectures that treat patients as agents interacting with systems and services that are coordinated using health information networks and interoperable electronic medical records. Broader Impacts: The system-level model of coordinated care has the potential for major impact on the health care system through the goal of promoting the adoption and spread of the Pathways Community HUB Model nationwide. The tool set employed to build the model to be demonstrated will be widely distributed through the efforts of RTSync to transfer its modeling and simulation technology to the market place as well as by the Rockville Institute in promulgating its coordinated care approaches to organizations set up to provide such care. The initial test bed to be employed for constructing and validating our model, represents generalizable case of ambulatory care coordination that enables scaling up to the general case of ambulatory care and further to general truly-integrated health care system. Such a system-level model could reliably predict the quality versus cost performance of an accountable care organization’s health care service structure. .See www.innovations.ahrq.gov/content.aspx?id=4097 for an overview of of the new insights into the Pathways Community HUB Model that will inform the design of the model’s certification program currently under development.
