Paper presented at the 34th International Conference of the System Dynamics Society, Delft, Netherlands - July 17-21, 2016
Full-Text available at:
https://www.systemdynamics.org/assets/conferences/2016/proceed/papers/P1332.pdf
Authors:
Mahmoud Elbattah and Owen Molloy
National University of Ireland Galway
mahmoud.elbattah@nuigalway.ie
Junnasandra Call Girls: 🍓 7737669865 🍓 High Profile Model Escorts | Bangalore...
The Economic Burden of Hip Fractures among Elderly Patients in Ireland: A Combined Perspective of System Dynamics and Machine Learning
1. The 34th International Conference of the System Dynamics Society
The Economic Burden of Hip Fracturesamong
Elderly Patients in Ireland: ACombined Perspective
of SystemDynamics and Machine Learning
Mahmoud Elbattah, Owen Molloy
m.elbattah1@nuigalway.ie
2. The 34th International Conference of the System Dynamics Society
Challenge to Healthcare: Population Ageing
2Source : Health Service Executive. Annual Report and Financial Statements, 2014.
3. The 34th International Conference of the System Dynamics Society
Our Focus: Hip Fracture Care in Ireland
• A good exemplar of elderly healthcare.
• Exponentially increasing with age.1
• Identified as one of the most serious injuries resulting in lengthy
hospital admissions and high costs.2
• Availability of empirical data through the Irish Hip Fracture Database
(IHFD).
3
Sources :1 Gullberg, B., Johnell, O. and Kanis, J.A., 1997. World-wide projections for hip fracture. Osteoporosis international, 7(5), pp.407-413.
2http://www.hse.ie/eng/services/publications/olderpeople/Executive_Summary_Strategy_to_Prevent_Falls_and_Fractures_in_Ireland%E2%80%99s_Ageing_Po
pulation.pdf
4. The 34th International Conference of the System Dynamics Society
Question of Interest
• With the growing trend of population ageing, how could be the
potential economic burden of elderly hip-fracture patients on the
healthcare system in Ireland over the next 10 years?
4
Given that:
Cost of Treatment =
(ED Cost) + (Hospital Inpatient Cost) +
(Outpatient Visits Cost) + (Long-Stay Care Cost)
5. The 34th International Conference of the System Dynamics Society
Related Questions
Q1) How to predict the inpatient length of stay in acute facilities?
Q2) How to predict the discharge destination for a hip-fracture
patient?
5
6. The 34th International Conference of the System Dynamics Society
Our Approach: Integrating Simulation Modeling with
Machine Learning
Machine Learning
Predict LOS and
Destination Discharge
Patient-Focused Perspective
+ Simulation Modeling
Modeling Projected
Flow of Elderly Patients
Population-Driven Perspective
Data-Driven Knowledge Domain Knowledge
8. The 34th International Conference of the System Dynamics Society
Sources of Data
• Irish Hip Fracture Database (IHFD). (Year 2013)
• Population projections from the Central Statistics Office (CSO).
• Additional population statistics with respect to CHOs from the Health
Intelligence Department.
8
9. The 34th International Conference of the System Dynamics Society
The Initial SD Model
9
InHospital
+
New Male Cases
+
New Female
Cases
PotentialMale
Patients
PotentialFemale
Patients
+
TotalElderly
Population
+
+
Hip Fracture Rate for
Elderly Males
Hip Fracture Rate for
Elderly Females
+
+
+
Discharge Fraction
Return Patients
Recurrence
Fraction
R
Home-Discharged
Long-Stay Care
Discharged
+
++
TotalDischarged
Patients
10. The 34th International Conference of the System Dynamics Society
Disaggregating the Model
10
InHospital
(CHO1)
New Male
Cases-CHO1
New Female
Cases-CHO1
Potential Male
Patients-CHO1
Potential Female
Patients-CHO1
Total Elderly
Population
Discharged
Patients- CHO1
InHospital
(CHO2)
New Male
Cases-CHO2
New Female
Cases-CHO2
Potential Male
Patients-CHO2
Potential Female
Patients-CHO2
Discharged
Patients-CHO2
Total Discharged
Patients
InHospital
(CHO3)
New Male
Cases-CHO3
New Female
Cases-CHO3
Potential Male
Patients-CHO3
Potential Female
Patients-CHO3
Discharged
Patients-CHO3
InHospital
(CHO4)
New Male
Cases-CHO4
New Female
Cases-CHO4
Potential Male
Patients-CHO4
Potential Female
Patients-CHO4
Discharged
Patients-CHO4
InHospital
(CHO5)
New Male
Cases-CHO5
New Female
Cases-CHO5
Potential Male
Patients-CHO5
Potential Female
Patients-CHO5
Discharged
Patients-CHO5
InHospital
(CHO6)
New Male
Cases-CHO6
New Female
Cases-CHO6
Potential Male
Patients-CHO6
Potential Female
Patients-CHO6
Discharged
Patients-CHO6
InHospital
(CHO7)
New Male
Cases-CHO7
New Female
Cases-CHO7
Potential Male
Patients-CHO7
Potential Female
Patients-CHO7
Discharged
Patients-CHO7
InHospital
(CHO8)
New Male
Cases-CHO8
New Female
Cases-CHO8
Potential Male
Patients-CHO8
Potential Female
Patients-CHO8
Discharged
Patients-CHO8
InHospital
(CHO9)
New Male
Cases-CHO9
New Female
Cases-CHO9
Potential Male
Patients-CHO9
Potential Female
Patients-CHO9
Discharged
Patients-CHO9
CHO1 Elderly
Population
CHO2 Elderly
Population
CHO3 Elderly
Population
CHO4 Elderly
Population
CHO5 Elderly
Population
CHO6 Elderly
Population
CHO7 Elderly
Population
CHO8 Elderly
Population
CHO9 Elderly
Population
Hip Fracture Rate
for Elderly Males
Hip Fracture Rate for
Elderly Females
11. The 34th International Conference of the System Dynamics Society
Generation of Patients
Community Health
Organisation (CHO)
No. of Simulation-Generated Patients
CHO1 151,850
CHO2 169,550
CHO3 142,450
CHO4 247,750
CHO5 187,050
CHO6 140,750
CHO7 191,900
CHO8 187,050
CHO9 180,650
11
Counts of patients generated per CHO over 50 simulation experiments.
12. The 34th International Conference of the System Dynamics Society
Machine Learning Models
• Regression Model -> Length of Stay.
• Classification Model -> Discharge destination.
• Machine learning algorithm: Random Forests.
12
13. The 34th International Conference of the System Dynamics Society
Machine Learning Models (cont’d)
13
Relative Absolute Error Relative SquaredError Coefficientof Determination
≈0.26 ≈0.17 ≈0.83
Average 10-fold cross-validationaccuracy of the LOS predictor
Average 10-fold cross-validationaccuracies of discharge destination classifier.
14. The 34th International Conference of the System Dynamics Society
Calculation of Cost
• Information on costs was acquired from the report “The economic
costs of falls and fractures in people aged 65 and over in Ireland”.1
14
Cost of Treatment = (ED Cost) + (Hospital Inpatient Cost) + (Outpatient
Visits Cost) + (Long-Stay Care Cost)
1 Gannon, B., O’Shea, E. and Hudson, E., 2007. The economic costs of falls and fractures in people aged 65 and over in Ireland. Irish Centre for Social
Gerontology, Galway.
15. The 34th International Conference of the System Dynamics Society
Results: Predicted Cost in 10 Years
15
16. The 34th International Conference of the System Dynamics Society
Results: Predicted Costs in CHOs
16
0
25,000,000
50,000,000
75,000,000
100,000,000
125,000,000
150,000,000
175,000,000
200,000,000
CHO1 CHO2 CHO3 CHO4 CHO5 CHO6 CHO7 CHO8 CHO9
AverageAccumulative
Home-Discharged Long-Stay Care Discharged
17. The 34th International Conference of the System Dynamics Society
Visualising Predicted Costs in CHOs
17
Heatmap: Overall predicted cost within every CHO.
18. The 34th International Conference of the System Dynamics Society
Study Limitations
• Only public acute hospitals were considered.
• The IHFD dataset did not evenly represent the 9 CHOs.
• The dataset covered only a single year (2013).
• The rate of hip fractures was assumed as a constant over the
simulated interval, however it might increase or decrease in reality.
18
19. The 34th International Conference of the System Dynamics Society
Study Limitations (cont’d)
• In-hospital cost of the patients aged 60-64 were considered the same
as 65-69.
• The study did not consider other potential costs such as the
ambulance costs.
• The study did not consider the indirect costs such as the quality of
life.
• The study did not distinguish between the patients who are
discharged to long-stay nursing homes and rehabilitation institutions.
19
20. The 34th International Conference of the System Dynamics Society
Discussion
• Why not use Simulation Modeling alone?
• Why not use Machine Learning alone?
20
22. The 34th International Conference of the System Dynamics Society
Studies Integrating Simulation & ML
22
23. The 34th International Conference of the System Dynamics Society
Studies Integrating Simulation & ML
23
24. The 34th International Conference of the System Dynamics Society
Acknowledgements
• System Dynamics Society.
• National Office of ClinicalAudit (NOCA), Ireland.
24
25. The 34th International Conference of the System Dynamics Society
THANK YOU!
Mahmoud Elbattah
m.elbattah1@nuigalway.ie
