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Simulation analysis of the consequences of shifting the balance of health care: a system dynamics approach

机译：转变医疗保健平衡后果的模拟分析：一种系统动力学方法

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Objectives: The shift in the balance of health care, bringing services 'closer to home', is a well-established trend. This study sought to provide insight into the consequences of this trend, in particular the stimulation of demand, by exploring the underlying feedback structure. nnMethods: We constructed a simulation model using the system dynamics method, which is specifically designed for the analysis of feedback structure. The model was calibrated to two cases of the shift in cardiac catheterization services in the UK. Data sources included archival data, observations and interviews with senior health care professionals. Key model outputs were the basic trends displayed by waiting lists, average waiting times, cumulative patient referrals, cumulative patient activity and cumulative overall costs. nnResults: Demand was stimulated in both cases via several different mechanisms. We revealed the roles for clinical guidelines and capacity changes, and the typical responses to imbalances between supply and demand. Our analysis also demonstrated the potential benefits of changing the goals that drive activity by seeking a waiting list goal rather than a waiting time goal. nnConclusions: Appreciating the wider consequences of shifting the balance of care is essential if services are to be improved overall. The underlying feedback mechanisms of both intended and unintended effects need to be understood. Using a systemic approach, more effective policies may be designed through coordinated programmes rather than isolated initiatives, which may have only a limited impact.
机译：目标：医疗保健平衡的转变，使服务“离家更近”，这是一个公认的趋势。这项研究试图通过探索潜在的反馈结构来提供对这一趋势的后果的洞见，尤其是刺激需求。 nnMethods：我们使用系统动力学方法构建了一个仿真模型，该模型是专门为分析反馈结构而设计的。该模型已针对英国心脏导管插入服务发生转移的两种情况进行了校准。数据来源包括档案数据，观察结果以及与高级卫生保健专业人员的访谈。关键模型输出是通过等待列表显示的基本趋势，平均等待时间，患者转诊累计，患者活动累积和总成本。结果：在两种情况下，通过几种不同的机制刺激了需求。我们揭示了临床指南和容量变化的作用，以及对供需不平衡的典型反应。我们的分析还表明，通过寻求等待名单目标而不是等待时间目标来改变推动活动的目标的潜在好处。 nn结论：如果要整体改善服务，则必须意识到转移医疗平衡所带来的广泛后果。需要理解预期和非预期作用的潜在反馈机制。使用系统方法，可以通过协调的计划而不是孤立的计划来设计更有效的政策，这可能只会产生有限的影响。

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