SD Modelling Case Studies
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    SD Modelling Case Studies SD Modelling Case Studies Presentation Transcript

    • Dynamic Modelling to Support CollaborativePlanning and Decision MakingCase StudiesOctober 2012David ReesFounding PartnerSynergia Ltd
    • Long-Term Planning in Local Government (2011/12)  (Work  Conducted  for  District  Council)  David  Rees,  Synergia,  Auckland,  New  Zealand   While  they  had  detailed  and  robust  financial  planning  underpinning   their  Long  Term  Plan,  a  District  Council  found  it  difficult  to  respond   quickly  to  requests  for  alteraIon  to  the  plan.  What  would  be  the   consequences,  for  example,  of  shiLing  a  major  capital  project  back  by   two  years?    What  would  be  the  consequences  of  adding  or  deleIng  any   of  the  projects  currently  in  the  plan?     While  their  financial  models  were  detailed  and  robust,  they  were   unable  to  answer  quesIons  such  as  these  in  an  easy,  flexible  and   speedy  way.     The  development  of  a  dynamic  simulaIon  model,   calibrated  with  their  own  financial  model,     provided  them  with  a  tool  that  enabled  them  to   conduct  mulIple  ‘what-­‐if’  scenarios.     The  model  ‘dashboard’  allows  them  to  quickly   modify  assumpIons  in  their  LTP  and  see  the   consequences  for  revenues,  expenditures  and   their  overall  financial  posiIon  over  the  lifeIme  of   the  LTP.    
    • Using Systems Modelling to Integrate Multiple Workstreams within Energy Sustainability Research (2011)   (Work  Conducted  for  University  of  Otago  Energy  Research  Centre)   David  Rees,  Synergia,  Auckland,  New  Zealand   Faced  with  data  coming  from  mulIple  research   streams  within  the  mulI-­‐disciplinary  research   team,  the  research  centre  wanted  ways  of   integraIng  their  findings.  The  purpose  of  the   modelling  was  to  disIll  the  key  findings  from  the   different  research  streams  and  any  uncover  issues   that  may  have  emerged  during  the  research   process.     Phase  II  of  that  research  project  is  now  underway   and  over  the  next  four  years  we  will  be  working   with  the  research  team,  using  dynamic  modelling   to  integrate  the  research  workstreams,  and  use  the   simulaIon  capabilites  to  explore  future  scenario   arising  out  of  the  research.  Phase II (2012 – 2016)Energy Culture IIEnergy sustainability in households,transport and SMEsRenewable Energy & the SmartGridExploring the supply and demanddynamics in a future based on extensiveuse of renewable energy sources
    • Regional Transport in Canterbury: Health Impact Analysis (2010)  (Work  Conducted  for  Environment  Canterbury)  David  Rees,  Synergia,  Auckland,  New  Zealand  Dr.  Adrian  Field,  Synergia,  Auckland,  New  Zealand   In  October  2009  Environment  Canterbury  iniIated  a  Health   Impact  Assessment  (HIA)  of  its  Regional  Land  Transport   Strategy.  The  aim  of  the  HIA  was  to  assess  the  links   between  transport  planning,  health  determinants,  and   health  outcomes  for  the  Canterbury  RLTS.       This  simulaIon  model  supported  the  HIA  by  exploring  the   links  between  transport  planning  and  health  outcomes  that   were  idenIfied  in  the  iniIal  scoping  workshop.     The  HIA  idenIfied  some  of  the  linkages,  such  as  those   between  safety  and  cycle  use  and  focused  its  analysis  on   three  key  areas;  safety,  mode  choice  and  healthier   environments.     The  aim  of  the  simulaIon  model  was  to  help  inform  policy   by  quanIfying  some  of  the  key  linkages  and  the  size  and   Iming  of  potenIal  health  impacts  resulIng  from  policy   opIons  being  considered  in  the  RLTS.  
    • Op$ons  for  Demen$a  Care  (2010/11)  (Work  Conducted  for  Health  Workforce  New  Zealand)  David  Rees,  Synergia,  Auckland,  New  Zealand  Geoff  McDonnell,  AdapIve  Care  Systems,  University  of  NSW  Dr.  Ray  Naden,  Clinical  Director,  Synergia     In  work  we  undertook  for  Health  Workforce  New  Zealand,  Synergia  explored  the   opportuniIes  for  improving  care  for  people  with  moderate  demenIa  in  the  home   and  community  secngs,  and  the  potenIal  impact  this  may  have  upon  admissions   to  aged  residenIal  care  (ARC).     The  report  provided  an  overview  of  the  modelling  used  to  explore  the  dynamics   of  home-­‐based  care  –  specifically  carer  stress  –  and  its  impact  upon  reducing   admissions  to  ARC.  The  report  then  provided  a  descripIon  of  the  models  of  care   required  to  bring  that  reducIon  about.     Because  demenIa  is  an  area  in  which  there  is  a  paucity  of  data,  our  modelling   had  to  bring  together  informaIon  from  a  number  of  sources.  Furthermore,  it  had   to  allow  a  range  of  scenarios  to  be  run  under  a  range  of  different  assumpIons.   The  model  allows  stakeholders  to  obtain  a  richer  understanding  of  what  the   future  possibiliIes  are,  the  constraints  upon  those  possibiliIes,  and  the  variables   that  have  an  impact  upon  determining  which  scenario  is  more  likely  to  come  to   pass.  
    • A Population-Based Approach  to  Planning  Mental  Health  Services  in  Primary  Care  (2010)  ((Work  Conducted  for  Health  Research  Council)  David  Rees,  Synergia,  Auckland,  New  Zealand  Philip  Gandar,  Synergia,  Auckland,  New  Zealand   The  issues  that  any  region  faces  in  planning  Primary  Mental  Health  Care   (PMHC)  are  varied  and  complex.  There  is  no  one  soluIon  that  can  be   applied  across  the  country,  and  because  of  this  it  is  important  that   planners  in  each  region  know  their  own  populaIon  and  its  needs,  and   the  characterisIcs  of  the  people  and  resources  who  can  respond  to   them.   This  model  is  designed  to  help  facilitate  conversaIons  about  PMHC  in   local  regions,  so  that  they  can  design  soluIons  that  best  fit  their   parIcular  circumstances.  It  takes  a  systems  approach  because  we  know   investing in that  any  soluIon  that  does  help  improve  mental  health  services  will  be   funds service improvement capability of required  to  address  many  issues.  IsolaIng  a  single  issue  simply  will  not   resources available service amount of work.  To  facilitate  the  conversaIons  we  have  designed  a  model  of  the   key  elements  within  PMHC  and  how  those  elements  link  together.  The   access resources investing in social levels demand determinants model of careinvesting in risk management need for MH adequacy of requirements model  is  based  on  our  conversaIons  with  planners  and  providers  within   each  DHB  and  focuses  on  key  themes  that  are  common  across  all.     Social services provider resources Strength model of change in care social strength average level of individual functioning attributes prevention & management of risk factors developing moderate developing severe quality of symptoms symptoms care No Significant Mild Moderate Severe Symptoms developing Symptoms becoming Symptoms becoming Symptoms symptoms moderate severe recovering recovering recovering mild moderate severe Requiring Secondary PMHC entering Care discharging from interventions secondary care secondary care <funds available> SMHC interventions service provision
    • Review  of  Aged-­‐Care  Workforce  (2010)  (Work  Conducted  for  Health  Workforce  New  Zealand)  David  Rees,  Synergia,  Auckland,  New  Zealand  Geoff  McDonnell,  AdapIve  Care  Systems,  University  of  NSW  Dr.  Ray  Naden,  Clinical  Director,  Synergia       A  System  Dynamics  (SD)  Model  was  designed  to  provide  a  framework  for  meeIng  the  challenge  of   Older People Receiving developing  and  managing  the  future  aged-­‐care  workforce.  It  did  so  by  describing  the  dynamic   Care relaIonships  between  older  people  in  need  of  health  care  services,  the  services  that  have  been   established  to  respond  to  those  needs  and  the  workforce  that  exists  within  each  service.     Service Configuration Central  to  the  model  is  the  key  quesIon;  “What  is  the  workload  that  the  workforce  has  to   undertake?”  Furthermore,  the  model  highlights  that  workload  is  a  funcIon  of  those  receiving  care   and  the  configuraIon  of  the  services  designed  to  provide  that  care.   Trainees Workforce   In  addiIon,  the  configuraIon  of  the  services  is  a  funcIon  of  the  work  needed  to  be  done  and  the   workforce  able  to  undertake  it.    As  a  consequence,  discussions  about  future  workforce   requirements  has  to  be  based  on  an  understanding  of  the  dynamic  interplay  between  each  of  the   three  elements.     The  need  for  care  was  modelled  by  using  funcIonal  impairment  as  the  key  modifiable  factor.  The   data  for  calculaIng  this  was  taken  from  the  Department  of  StaIsIcs  and  from  the  Australian   Bureau  of  StaIsIcs  survey  of  disability,  ageing  and  carers,  which  was  calibrated  for  the  New   Zealand  populaIon.  This  survey  (which  is  a  self  assessment)  provided  the  best  available  data  on   the  likely  levels  of  funcIonal  impairment  (disability)  in  the  populaIon.  FuncIonal  impairment  was   defined  as  any  limitaIon,  restricIon  or  impairment,  (physical  or  cogniIve)  which  has  lasted  or  is   likely  to  last  for  at  least  6  months  and  restricts  everyday  acIviIes.     Model  projecIons  indicate  that  those  65+  with  severe  funcIonal  impairment  will  rise  from   127,874  in  2010  to  207,409  by  2026.     Research  indicates  that  the  rates  at  which  people  develop  funcIonal  impairment  could  be  reduced   by  as  much  as  30%.  If  this  did  occur  the  numbers  of  people  with  severe  funcIonal  impairment   would  rise  to  175,178,  by  2026;  a  reducIon  of  43,000  when  compared  with  the  baseline.    
    • Exploring the Impact of Adherence to Asthma Medication onHealthcare Utilisation (2010)  (Work  Conducted  for  private  healthcare  provider)  David  Rees,  Synergia,  Auckland,  New  Zealand   Recently  a  private  healthcare  provider  completed  a  trial  of  a  medicaIon   adherence  programme,  which  involved  targeted  text  messaging   designed  to  change  percepIons  and  improve  adherence  to  asthma   preventer  medicaIon.  The  results  were  impressive,  showing  a  39%   increase  in  adherence,  versus  the  baseline,  aLer  6  months.     The  quesIon  that  this  raised  for  the  Company  was  whether  or  not  this   improvement  could  have  significant  enough  impacts  upon  healthcare   uIlisaIon  to  jusIfy  further  investments  in  the  programme.  Of  special   interest  was  whether  or  not  the  impact  upon  healthcare  uIlisaIon   could  be  significant  enough  to  interest  Pharmac  in  supporIng  the   programme.     To  help  answer  this  Synergia  was  commissioned  to  develop  a  dynamic   simulaIon  model  that  could  explore  the  impact  of  increased   adherence,  generated  by  programme,  on  healthcare  uIlisaIon.    This   would  then  enable  the  Company  to  make  a  more  rigorous  assessment   of  its  commercial  viability  in  the  New  Zealand  market.    
    • A  Whole  of  System  Approach  to  Compare  Op$ons  for    CVD  Interven$ons  in  Coun$es  Manukau,  New  Zealand  (2009)  (Australia  New  Zealand  Journal  Of  Public  Health.  (2012)  Volume  65,  Issue  3.)  Timothy  Kenealy,  SecIon  of  Integrated  Care,  South  Auckland  Clinical  School,  University  of  Auckland,  New  Zealand  David  Rees,  Synergia,  Auckland,  New  Zealand  Nicolese  Sheridan,  SecIon  of  Integrated  Care,  South  Auckland  Clinical  School,  University  of  Auckland,  New  Zealand    Allan  Moffis,  Director  of  Primary  Care,  CounIes  Manukau  District  Health  Board,  New  Zealand  Sarah  Tibby,  Programme  Manager,  Long  term  CondiIons,  CounIes  Manukau  District  Health  Board,  New  Zealand  Jack  Homer,  Homer  ConsulIng,  Voorhees,  New  Jersey,  United  States.    Objec$ve  To  assess  the  usefulness,  to  planning  and  funding  decision  makers,  of  a  naIonal  and  a  local  System  Dynamics  model  of  cardiovascular  disease.  Methods  In  an  iteraIve  process,  an  exisIng  naIonal  model,  based  on  earlier  work  by  Jack  Homer,  was  populated  with  local  data  and  was  presented  to   Tobacco taxes andstakeholders,  in  CounIes  Manukau,  New  Zealand.  They  explored  the   Quality of primary care provision Use of primary care Anti-smoking sales/marketing regulations social marketingplausibility,  usefulness  and  implicaIons  of  the  model.  Data  were   Sources of Use of smoking quit products andcollected  from  30  people  using  quesIonnaires,  and  from  field  notes  and   stress servicesinterviews,  both  of  which  were  themaIcally  analysed.   Use of mental health services by stressed Smoking bans at work and public placesResults   Stressed Use of quality Sm oking fraction primary carePotenIal  users  readily  understood  the  model  and  acIvely  engaged  in   Prevale nce Secondhanddiscussing  it.  None  disputed  the  overall  model  structure,  but  most   Diagnosis and control smokewanted  extensions  to  the  model  to  elaborate  areas  of  specific  interest   Particulate airto  them.    Local  data  made  lisle  qualitaIve  difference  to  data   Uncontrolled pollution Chronic DisorderinterpretaIon  but  was  nevertheless  considered  to  be  a  necessary  step   Pre vale nces Poor dietto  support  confident  local  decisions.     fraction High blood pre ssureConclusion   High First-tim e CV e vent and death Obesity cholesterolSome  limitaIons  to  the  model  and  its  use  were  recognised,  but  users   Prev alence Diabetes rates Recurrent CV ev ent and de athcould  allow  for  these  and  sIll  derive  use  from  the  model  to  qualitaIvely   Inadequate ratescompare  decision  opIons.   physical activity fraction Non-CVD Post-CVDImplica$ons   Use of weight loss People Popn First-tim e PopnThe  System  Dynamics  modelling  process  is  useful  in  complex  systems   services by obese turning 35 events surv ived CV e vents and deaths Non-CVD Popn Post-CVD Popnand  is  likely  to  become  established  as  part  of  the  rouInely  used  suite  of   deaths deathstools  used  to  support  complex  decisions  in  CounIes  Manukau  District  Health  Board.  Keywords  Cardiovascular  diseases,  system  dynamics,  populaIon  health,  decision  making,  health  care  quality  access  and  evaluaIon