使用系统动力学决策支持工具考察老年人急诊干预措施的效果。
Examining the effect of interventions in emergency care for older people using a system dynamics decision support tool.
机构信息
Southampton Business School, University of Southampton, Highfield, Southampton, UK.
Department of Health Policy, London School of Economics and Political Science, London, UK.
出版信息
Age Ageing. 2023 Jan 8;52(1). doi: 10.1093/ageing/afac336.
BACKGROUND
Rising demand for Emergency and Urgent Care is a major international issue and outcomes for older people remain sub-optimal. Embarking upon large-scale service development is costly in terms of time, energy and resources with no guarantee of improved outcomes; computer simulation modelling offers an alternative, low risk and lower cost approach to explore possible interventions.
METHOD
A system dynamics computer simulation model was developed as a decision support tool for service planners. The model represents patient flow through the emergency care process from the point of calling for help through ED attendance, possible admission, and discharge or death. The model was validated against five different evidence-based interventions (geriatric emergency medicine, front door frailty, hospital at home, proactive care and acute frailty units) on patient outcomes such as hospital-related mortality, readmission and length of stay.
RESULTS
The model output estimations are consistent with empirical evidence. Each intervention has different levels of effect on patient outcomes. Most of the interventions show potential reductions in hospital admissions, readmissions and hospital-related deaths.
CONCLUSIONS
System dynamics modelling can be used to support decisions on which emergency care interventions to implement to improve outcomes for older people.
背景
紧急和紧急护理需求的不断增长是一个重大的国际问题，老年人的治疗效果仍不理想。开展大规模的服务开发在时间、精力和资源方面都代价高昂，且不能保证治疗效果的改善；计算机模拟建模提供了一种替代方法，具有低风险和低成本的特点，可用于探索可能的干预措施。
方法
我们开发了一个系统动力学计算机模拟模型，作为服务规划者的决策支持工具。该模型代表了患者从呼救到急诊就诊、可能住院、出院或死亡的整个紧急护理过程中的流动情况。该模型针对五种不同的基于证据的干预措施（老年急诊医学、前门虚弱、医院到家、主动护理和急性虚弱病房）进行了验证，以评估患者的治疗效果，如与医院相关的死亡率、再入院率和住院时间。
结果
模型输出估计与经验证据一致。每种干预措施对患者的治疗效果都有不同程度的影响。大多数干预措施显示出降低住院率、再入院率和与医院相关死亡率的潜力。
结论
系统动力学建模可用于支持决策，选择实施哪些紧急护理干预措施以改善老年人的治疗效果。
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