This document discusses using whole systems modeling to aid in commissioning care for long-term health conditions like depression. It describes a case study conducted in Sheffield, England that developed a mathematical model to evaluate potential costs and health impacts of redesigning depression care services. The study analyzed several service redesign options and found some to be cost-effective, with pilots currently underway. Whole systems modeling provides a framework to consider the entire healthcare system and how changes might impact people flowing through different services.

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Ben Kearns
Research Associate
The University of Sheffield
Whole Systems Modelling to Aid
Commissioning of Long-Term
Conditions

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 Often require complex pathways of care.
 Chronic conditions → repeated use of NHS services.
 Need for high-quality care pathways = need for
evidence-based planning and commissioning.
NHS services and people with long-
term conditions

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 Systematic framework for evaluating the potential
costs and health-impact of service re-designs.
 Move from considering single parts of the system
to the whole system.
Whole systems modelling

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 Improving Quality & Effectiveness of Services,
Therapies and Self-management in longer-term
depression (IQuESTs study).
 Translate research into routine NHS care.
 Evaluate potential service re-designs to improve
self-management in Sheffield.
Case-study: depression

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 Interviews with local service experts (managers,
service users, clinicians, academics).
 Conceptual modelling to understand current care
pathways in Sheffield.
 Mathematical model for health economic evaluation.
 Disease-level model (depression) and service-level
model (care pathways).
Process

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Whole systems model:
Long-term depression
STEPPEDCARE→
Not engaged
with services

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 Three service re-designs evaluated, shown to be
potentially cost-effective, currently being piloted.
 Demonstrates feasibility of using whole-systems
models to inform evidence-based decision making.
Tosh, Kearns, Brennan et al (2013). Innovation in health economic modelling
of service improvements for longer-term depression: demonstration in
a local health community. BMC health services research, 13(1), 150.
http://www.biomedcentral.com/1472-6963/13/150
Results

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 Move towards patient-centred modelling:
 Engagement with services and impact of co-
morbidities.
 Diabetes-depression case-study.
 University of Sheffield training course: “Planning
and commissioning whole-pathways of care for
patients with long-term conditions”.
Implications for future work

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The below applies to the IQuESTS study.
NIHR Collaborations for Leadership in Applied Health Research and
Care for South Yorkshire (CLAHRC SY) acknowledges funding from
the National Institute for Health Research. The views and opinions
expressed are those of the authors, and not necessarily those of the
NHS, the NIHR or the Department of Health.
CLAHRC SY would also like to acknowledge the participation and
resources of our partner organisations. Further details can be found at
http://www.clahrc-sy.nihr.ac.uk..
Acknowledgement

10. 06/06/14 © The University of Sheffield
The below applies to the IQuESTS study.
NIHR Collaborations for Leadership in Applied Health Research and
Care for South Yorkshire (CLAHRC SY) acknowledges funding from
the National Institute for Health Research. The views and opinions
expressed are those of the authors, and not necessarily those of the
NHS, the NIHR or the Department of Health.
CLAHRC SY would also like to acknowledge the participation and
resources of our partner organisations. Further details can be found at
http://www.clahrc-sy.nihr.ac.uk..
Acknowledgement