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A simulation study of a long-term neurodevelopmental care pathway for children with congenital heart disease
Pakhi Sharma1,2, Thomasina Donovan3, Bridget Abell3
1Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia. p32.sharma@qut.edu.au.
Insights
Simulation modeling helps understand neurodevelopmental care for children with congenital heart disease (CHD). Enhancing screening improves identification of developmental delays and intervention access, informing future care planning.
Area of Science:
- Pediatric Cardiology
- Developmental Pediatrics
- Health Services Research
Background:
- Children with congenital heart disease (CHD) require ongoing neurodevelopmental care.
- Understanding care pathway delivery and uptake is crucial for implementation and resource planning.
- This study utilized simulation modeling to explore outcomes of a neurodevelopmental care pathway for children with CHD.
Purpose of the Study:
- To apply simulation modeling to understand outcomes from a neurodevelopmental care pathway for children with CHD.
- To explore how variations in screening and referral processes impact the identification of developmental concerns and intervention access.
- To provide insights for policy and resource planning for future neurodevelopmental care pathways.
Main Methods:
- Developed a simulation model using data from a Queensland program.
- Modeled health service interactions for neurodevelopmental screening, assessment, and early intervention up to five years.
- Explored hypothetical scenarios to assess the impact of screening and referral changes on developmental concern identification and intervention referrals.
Main Results:
- Based on available data, 58% of the cohort remained under routine surveillance, and 25% accessed early intervention.
- Increased screening scenarios projected up to 55% of the cohort having a developmental concern identified.
- Up to 45% of the cohort could have a developmental delay identified following assessment in enhanced screening scenarios.
Conclusions:
- Simulation modeling effectively elucidated outcomes and health service interactions within a neurodevelopmental care pathway.
- Neurodevelopmental screening emerged as the most influential stage impacting downstream outcomes, highlighting its strategic importance.
- Findings offer a framework for evaluating similar pathways and can inform policy and resource allocation for improved child development services.
Background:
Ongoing neurodevelopmental care is essential for children with congenital heart disease (CHD). Understanding delivery and uptake of neurodevelopmental care pathways can inform implementation and resource planning. This study applied simulation modelling to explore outcomes from a neurodevelopmental care pathway for children with CHD.
Methods:
The model was developed using data from a Queensland program to explore health service interactions for neurodevelopmental screening, formal assessment, and early intervention, up to five years. Modelling was intended to provide a baseline understanding of the pathway, rather than evaluating against a reference standard. Hypothetical scenarios explored how changes in screening and referrals influenced the identification of developmental concerns, and how developmental concern severity affected intervention referrals.
Results:
Based on available data, 58% of the cohort remained under routine surveillance and 25% had accessed early intervention for one or more developmental delays. Scenarios defined by increased screening projected up to 55% of the cohort having a developmental concern identified during screening and 45% having a developmental delay identified following assessment.
Conclusion:
Simulation modelling was useful for understanding outcomes from a neurodevelopmental pathway and how differences in screening and assessment affected health service interactions. Findings may inform policy and resource planning for future neurodevelopmental pathways.
Impact:
This study shows that simulation modelling is a useful approach for evaluating a neurodevelopmental care pathway for children with CHD, to understand movement through neurodevelopmental screening, assessment, and interventions. Scenario-based modelling provides insights into factors influencing pathway engagement, contributing evidence to strengthen understanding of service gaps and areas where improvements can most effectively impact engagement and resourcing. This study identifies neurodevelopmental screening as the most influential stage impacting downstream outcomes, underscoring its importance as a strategic intervention point. This study's approach provides a general framework for evaluating similar pathways and a potential baseline for assessing future policy or service changes.
