Dynamic Modelling to Support Planning and Decision Making

Case Studies
July 2012

David Rees Founding Partner Synergia Ltd

A Whole of System Approach to Compare Op4ons for CVD Interven4ons in Coun4es Manukau, New Zealand (2009)
(Australia New Zealand Journal Of Public Health. (2012) Volume 65, Issue 3.) Timothy Kenealy, SecKon of Integrated Care, South Auckland Clinical School, University of Auckland, New Zealand David Rees, Synergia, Auckland, New Zealand NicoleSe Sheridan, SecKon of Integrated Care, South Auckland Clinical School, University of Auckland, New Zealand Allan MoS, Director of Primary Care, CounKes Manukau District Health Board, New Zealand Sarah Tibby, Programme Manager, Long term CondiKons, CounKes Manukau District Health Board, New Zealand Jack Homer, Homer ConsulKng, Voorhees, New Jersey, United States. Objec4ve To assess the usefulness, to planning and funding decision makers, of a naKonal and a local System Dynamics model of cardiovascular disease. Methods In an iteraKve process, an exisKng naKonal model, based on earlier work by Jack Homer, was populated with local data and was presented to Tobacco taxes and Use of sales/marketing Quality of primary stakeholders, in CounKes Manukau, New Zealand. They explored the Anti-smoking primary care regulations care provision social marketing Use of smoking quit plausibility, usefulness and implicaKons of the model. Data were products and Sources of services stress collected from 30 people using quesKonnaires, and from eld notes and Smoking bans at Use of mental health interviews, both of which were themaKcally analysed. work and public services by stressed places Results Stressed Use of quality Sm oking fraction primary care Prevale nce PotenKal users readily understood the model and acKvely engaged in Secondhand Diagnosis smoke discussing it. None disputed the overall model structure, but most and control wanted extensions to the model to elaborate areas of specic interest Particulate air pollution to them. Local data made liSle qualitaKve dierence to data Uncontrolled Chronic Disorder interpretaKon but was nevertheless considered to be a necessary step Pre vale nces Poor diet High blood to support condent local decisions. fraction pre ssure First-tim e CV Conclusion High e vent and death Obesity cholesterol rates Prev alence Some limitaKons to the model and its use were recognised, but users Diabetes could allow for these and sKll derive use from the model to qualitaKvely Inadequate physical activity compare decision opKons. fraction Non-CVD Post-CVD Popn Implica4ons Popn Use of weight loss People First-tim e services by obese turning 35 events surv ived The System Dynamics modelling process is useful in complex systems Non-CVD Popn Post-CVD Popn deaths and is likely to become established as part of the rouKnely used suite of deaths tools used to support complex decisions in CounKes Manukau District Health Board. Keywords Cardiovascular diseases, system dynamics, populaKon health, decision making, health care quality access and evaluaKon

Recurrent CV ev ent and de ath rates

CV e vents and deaths

Review of Aged-Care Workforce (2010)

(Work Conducted for Health Workforce New Zealand) David Rees, Synergia, Auckland, New Zealand Geo McDonnell, AdapKve Care Systems, University of NSW Dr. Ray Naden, Clinical Director, Synergia

Older People Receiving Care

Service Configuration

Trainees

Workforce

A System Dynamics (SD) Model was designed to provide a framework for meeKng the challenge of developing and managing the future aged-care workforce. It did so by describing the dynamic relaKonships 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. Central to the model is the key quesKon; What is the workload that the workforce has to undertake? Furthermore, the model highlights that workload is a funcKon of those receiving care and the conguraKon of the services designed to provide that care. In addiKon, the conguraKon of the services is a funcKon 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 funcKonal impairment as the key modiable factor. The data for calculaKng this was taken from the Department of StaKsKcs and from the Australian Bureau of StaKsKcs survey of disability, ageing and carers, which was calibrated for the New Zealand populaKon. This survey (which is a self assessment) provided the best available data on the likely levels of funcKonal impairment (disability) in the populaKon. FuncKonal impairment was dened as any limitaKon, restricKon or impairment, (physical or cogniKve) which has lasted or is likely to last for at least 6 months and restricts everyday acKviKes. Model projecKons indicate that those 65+ with severe funcKonal impairment will rise from 127,874 in 2010 to 207,409 by 2026. Research indicates that the rates at which people develop funcKonal impairment could be reduced by as much as 30%. If this did occur the numbers of people with severe funcKonal impairment would rise to 175,178, by 2026; a reducKon of 43,000 when compared with the baseline.

Op4ons for Demen4a Care (2010/11)

(Work Conducted for Health Workforce New Zealand) David Rees, Synergia, Auckland, New Zealand Geo McDonnell, AdapKve Care Systems, University of NSW Dr. Ray Naden, Clinical Director, Synergia

This report builds upon a phase 1 report (Workforce for the Care of Older People 23rd December 2010) that provided an overview of key issues within the aged- care sector, exploring alternaKve models of care and implicaKons for the aged- care workforce. This report further develops the ideas presented in that report and applies them to the specic case of people with demenKa, with moderate impairment. This report is not an overview of demenKa, nor does it try to describe all the opKons available. Instead, it focuses on one specic aspect, namely the opportuniKes for improving care for people with moderate demenKa in the home and community semng and the potenKal impact that may have upon admissions to aged residenKal care (ARC). The report provided an overview of the modelling used to explore the dynamics of home-based care specically carer stress and its impact upon reducing admissions to ARC. The report then providds a descripKon of the models of care required to bring that reducKon about. Because demenKa is an area in which there is a paucity of data, our modelling had to bring together informaKon from a number of sources. Furthermore, it had to allow a range of scenarios to be run under a range of dierent assumpKons. The model allows stakeholders to obtain a richer understanding of what the future possibiliKes are, the constraints upon those possibiliKes, 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 soluKon that can be applied across the country, and because of this it is important that planners in each region know their own populaKon and its needs, and the characterisKcs of the people and resources who can respond to them. This model is designed to help facilitate conversaKons about PMHC in local regions, so that they can design soluKons that best t their parKcular circumstances. It takes a systems approach because we know that any soluKon that does help improve mental health services will be required to address many issues. IsolaKng a single issue simply will not work. To facilitate the conversaKons we have designed a model of the key elements within PMHC and how those elements link together. The model is based on our conversaKons with planners and providers within each DHB and focuses on key themes that are common across all.

funds available access levels

investing in service improvement

capability of resources service demand amount of resources model of care requirements

investing in social determinants investing in risk management change in social strength prevention & management of risk factors No Significant Symptoms

Social Strength

need for MH services

adequacy of provider resources

average level of functioning

model of care individual attributes

developing moderate symptoms Mild Symptoms becoming moderate Moderate Symptoms

developing severe symptoms Severe Symptoms

quality of care

developing symptoms

becoming severe

recovering mild

recovering moderate

recovering severe entering secondary care <funds available> Requiring Secondary Care discharging from secondary care SMHC interventions service provision

PMHC interventions

Exploring the Impact of Adherence to Asthma Medication on Healthcare Utilisation (2010)

(Work Conducted for private healthcare provider) David Rees, Synergia, Auckland, New Zealand

Recently a private healthcare provider completed a trial of a medicaKon adherence programme, which involved targeted text messaging designed to change percepKons and improve adherence to asthma preventer medicaKon. The results were impressive, showing a 39% increase in adherence, versus the baseline, aner 6 months. The quesKon that this raised for the Company was whether or not this improvement could have signicant enough impacts upon healthcare uKlisaKon to jusKfy further investments in the programme. Of special interest was whether or not the impact upon healthcare uKlisaKon could be signicant enough to interest Pharmac in supporKng the programme. To help answer this Synergia was commissioned to develop a dynamic simulaKon model that could explore the impact of increased adherence, generated by programme, on healthcare uKlisaKon. This would then enable the Company to make a more rigorous assessment of its commercial viability in the New Zealand market.