Online Workshop: Improving Patient Care Pathways

Improving Patient Care
Pathways
Claire Cordeaux: Executive Director, Healthcare

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
Presenter
Claire Cordeaux
Executive Director, Healthcare SIMUL8
SIMUL8 Corporation
claire.c@SIMUL8.com

• Understanding patient care through pathways
• How simulation can help
• Examples
• Standard of Care
• Sharing across a community
• How you can get involved
Agenda

Patient Care Pathways
Routinely used to understand and improve
practice
• Services
• Clinical practice
• Disease

Patient Care Pathways: Services
Process flow through services

Patient Care Pathways: Clinical Practice
Used to show best clinical practice.
Map of Medicine

Patient Care Pathways:
Disease Progression
Show progression through disease states
over time.

Our Approach to Simulating Pathways
Combining disease state transitions with
best practice and service access.
Why?
• Test impact of service redesign on disease
progression
• Genericized – can be used and localised by any
group interested improving pathways for patients
with the same condition

Disease Transitions: State Charts
• Define all disease
states patients can
transition to.
• Input the transitions
between states.
(Rates, %, Time)
• As simulation runs
patients will
transition to an from
states based on the
inputted rules.

Service Model
The disease transition model is linked to a service or
treatment model.
As patients transition into different states they use different
service. They trigger events in a DES model.

Best Clinical Practice
New interventions, best clinical practice,
service redesign can all be tested for impact
on:
Cost, Resource, Activity, Waiting times
AND
Disease Progression

Case Study 1: HIV
What is the impact of screening?
What is the impact of increasing frequency
of attendance to improve adherence?
• on future burden of disease
• projected treatment costs for the service

Age-banded
population
projections
Age-banded
disease
prevalence
Demand
1.23m x HIV 0.465% = 2531
Simulating Demand

Simulated Demand:
Catchment Population
The projected population is decreasing

25% of patients are
undiagnosed and use
this pathway.
Undiagnosed patients
can infect others.
Late diagnosis leads to
becoming symptomatic
and very sick.
Diagnosis (Current State)

Diagnosis (Current State)
Successful ART leads
to near normal life
expectancy
Cost per year if
symptomatic and
AIDs
75% of patients are
diagnosed and use this
pathway.
Diagnosed but
untreated can infect
others
Late diagnosis leads to
becoming symptomatic
and very sick

Costs (indicative only)
Cost $
Diagnosis 100
Follow up Appointment
and Drug therapy every 6
months
9,000
HIV symptoms (annual) 25,000
AIDS (1 year only) 50,000

Activity Results
These results represent no change for next
5 years.
0
2000
4000
6000
8000
10000
12000
14000
1 2 3 4 5
new infections
ART
Follow ups

What if screening reduces undiagnosed to 15%?
Costs decrease over time as fewer patients develop HIV
Symptoms and Aids and fewer are infected, although follow ups
increase.
0
50000000
100000000
150000000
200000000
250000000
1 2 3 4 5
Screening Costs
Costs
0
500
1000
1500
2000
2500
1 2 3 4 5
Screening Aids
Aids
Screening HIV
Sympt
HIV sympt
0
2000
4000
6000
8000
10000
12000
14000
1 2 3 4 5
Follow ups
ScreeningFollow
ups
Scenario 1 Results

What if we see patients every 3 instead of very 6
months and this increases successful ART?
Scenario 2

Scenario Results:
Increasing Treatment Frequency
Costs increase but infections reduce. Symptomatic
patients reduce in years 4 and 5
0
50000000
100000000
150000000
200000000
250000000
1 2 3 4 5
Screening Costs
Costs
Supported ART Costs
0
50
100
150
200
250
1 2 3 4 5
New infection baseline
New Infection
Screening
New infection
Supported ART
0
500
1000
1500
2000
2500
1 2 3 4 5
Baseline HIV sympt
Screening HIV Sympt
Support ART HIV Sympt

What Resources are Required?
0
2000
4000
6000
8000
10000
12000
14000
16000
1 2 3 4 5
Baseline follow ups
Sreening Follow ups
Support ART Follow ups
Follow ups increase in each scenario – with
100 weekly appointments wait times are
unacceptable.

Resource requirements
Increasing weekly appointments to 250
brings wait times in line with requirements

Case Study 2: Dementia

Results after multiple runs

Template Simulations
What are the key features of any disease
pathway?
Share your thoughts via our survey monkey and
we will report back.

Standard of Care
Imagine a simulated pathway including:
• Expected demand from population health predictions and
disease progression
• Evidence-based best clinical practice
• Localizable to individual providers and populations
Answering questions:
• What if I implement best practice?
• What will this look like in 3-5 years time?
• What resources will I need?
• How much will it cost/what income will I earn?
• Will I have patients waiting if I don’t increase staffing?
• What will patient outcomes be?

Share and Manage Pathways
on the Web
Have multiple user logins to access a suite of simulation models.

Create Simulation Suites
Upload multiple models which user can run, change, SAVE and EXPORT
results from. These users can also share these with others.

Manage Access
Create localized simulations and assign them so that only specific users can
view particular simulations.

Do Once and Share
Our offer to you
Help us build pathways we can share.
Send us your pathway suggestions and we
will choose one to build and share using our
new technology
Email to healthteam@simul8.com

QUESTIONS
Please forward any topics you would like to
see covered to claire.c@simul8.com
Continue the discussion on SIMUL8 in
Health – LinkedIn Group
September Workshop – “Optimizing
Outpatient Operations – Staffing &
Scheduling”.

Online Workshop: Improving Patient Care Pathways

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