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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >CoolSim: using industrial modeling techniques to examine the impact of selective head cooling in a model of perinatal regionalization.
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CoolSim: using industrial modeling techniques to examine the impact of selective head cooling in a model of perinatal regionalization.

机译：CoolSim：使用工业建模技术检查围产期区域化模型中选择性头部冷却的影响。

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OBJECTIVE: A selective head-cooling device for the treatment of moderate to severe hypoxic-ischemic encephalopathy has been approved by the Food and Drug Administration for use in the United States. To reflect the complexity of health care delivery at the systems level, we used the industrial modeling technique of discrete event simulation to analyze the impact of various deployment strategies for selective head cooling and its partner technology, amplitude-integrated electroencephalography. METHODS: We modeled the course through the perinatal system of all births in Massachusetts over a 1-year period. Cohort and care characteristics were drawn from existing databases. Results of a recently published trial were used to estimate the effects of selective head cooling. One thousand cohort replications were conducted to assess uncertainty. Several policy alternatives were examined, including no use of selective head cooling and scenarios that altered the number and placement of selective head-cooling and amplitude-integrated electroencephalography units throughout the state. Patient-level outcome and cost data were assessed. RESULTS: For all scenarios tested, the use of amplitude-integrated electroencephalography/selective head cooling resulted in better outcomes at lower cost. However, substantial differences in transfer rates, failure-to-cool rates, and total costs were seen across scenarios. Optimal decision-making regarding the number and placement of devices led to a 16% improvement in cost savings and a 10-fold decrease in failure-to-cool rates, compared with other deployment scenarios. These results were insensitive to significant changes in model inputs. CONCLUSIONS: On the basis of currently available data, the package of amplitude-integrated electroencephalography and selective head cooling seems to be an economically desirable intervention. Quantifiable techniques to assess system-wide technology performance provide a powerful approach to informing decisions regarding the structure and function of health care systems.
机译：目的：用于治疗中度至重度缺氧缺血性脑病的选择性头部冷却装置已获得美国食品药物管理局的批准，可在美国使用。为了反映系统级医疗服务的复杂性，我们使用离散事件模拟的工业建模技术来分析选择性头部冷却及其伙伴技术（振幅积分脑电图）的各种部署策略的影响。方法：我们通过围产期系统对马萨诸塞州所有婴儿在1年期间的病程进行了建模。队列和护理特征来自现有数据库。最近发表的一项试验的结果用于估计选择性喷头冷却的效果。进行了1000例队列研究以评估不确定性。研究了几种政策选择，包括不使用选择性头部冷却和改变整个州选择性头部冷却和振幅积分脑电图单元的数量和位置的方案。评估了患者水平的结果和费用数据。结果：对于所测试的所有情况，使用振幅积分脑电图/选择性头部冷却可以以较低的成本获得更好的结果。但是，在各种情况下，都可以看到传输速率，冷却失败率和总成本方面的显着差异。与其他部署方案相比，关于设备数量和放置位置的最佳决策可以使成本节省提高16％，冷却故障率降低10倍。这些结果对模型输入的重大变化不敏感。结论：根据目前可获得的数据，振幅积分脑电图和选择性头部冷却的包装似乎是经济上理想的干预措施。评估全系统技术性能的可量化技术为告知有关医疗保健系统结构和功能的决策提供了一种有力的方法。

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