Modelling health systems: delivering care to older people with hip fracture
Harrow School of Computer Science, University of Westminster, London, UK
Kingston Hospital NHS Trust, Kingston, UK
Harrow School of Computer Science, University of Westminster, London, UK
Fractured neck of femur, or hip fracture, is associated with osteoporosis and thus the incident rate is significantly higher in older people. In the UK, the care for older people with hip fracture has been identified as an area with the highest potential for improving the quality and value of clinical care through changes in the organisation of care delivery. Computer simulation is a common approach to evaluating the likely response of a health system to changes in organisation, management and policy. However, few health systems have used simulations for re-engineering care delivery. The difficulties in understanding and modelling the actual care process and the lack of a systematic method for developing model requirements are often cited as the main inhibiting factors.
The aim of this research is to create a method for capturing, storing and presenting details of the flow of patients through the care process. The specific objectives are
- to describe the activities involved in the care for older people presenting with symptoms of fractured neck of femur to an acute care hospital in the UK, and
- to develop requirements for simulation models of the flow of older patients with fractured neck of femur through the care process.
For describing the care activities we collect information by conducting semi-structured interviews and organising on-site meetings with care givers and hospital managers, and by observing clinical rounds and multi-disciplinary team meetings. For storing and presenting the collected information, and for developing model requirements we employ Unified Modelling Language (UML) diagrams to represent the activities involved in the care process and to describe the behaviour of the identified care system actors (for example, patients, surgeons, physicians etc.). The UML diagrams we employ are:
- use case and use case diagram to capture the functional requirements of the care system
- activity diagram to capture the sequence and conditions of the progress of patients through care activities
- state diagram to capture the behaviour of care system actors
- class diagram to capture the structure of the care system
The benefits arising from this research are considerable. We will develop and test a novel method for developing requirements for simulations of patient flow through the care process that can be used by health care analysts in other studies. The generated model requirements will feed directly into future simulation studies of evaluating the impact of suggested changes in the care of older people with fractured neck of femur. The knowledge gained from this research will also help guide best practice in preparing an effective integrated care pathway in the collaborating hospital.
This research is partially supported by a Strategic Promotion for Ageing Research Capacity (SPARC) grant.
