模拟NHS英格兰111对初级保健服务的需求:一个离散事件模拟
Richard Pilbery1, Madeleine Smith2, Jonathan Green3
1Research and Development, Yorkshire Ambulance Service NHS Trust, Wakefield, UK r.pilbery@nhs.net.
BMJ open
|September 6, 2023
概括
模拟医疗保健表明,改善初级保健准入可以显著减少紧急呼叫和访问. 然而,这需要将初级保健能力几乎增加一倍,这引发了对实用性和成本效益的质疑.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
- 模拟建模模的模拟模型.
背景情况:
- 国家卫生服务 (NHS) 111服务处理大量电话,许多患者被分组到初级保健.
- 及时获得初级保健对于有效的医疗保健和患者的结果至关重要.
- 当前的系统压力可能会影响提供及时初级保健服务的能力.
研究的目的:
- 为使用NHS 111并被分组到初级保健的患者建模当前的医疗保健系统.
- 模拟重新配置系统的影响,以确保及时接触初级保健.
- 评估紧急服务利用率和急诊室 (ED) 出勤率的潜在变化.
主要方法:
- 使用离散事件模拟来建模医疗保健系统.
- 这项研究使用了来自约克郡NHS 111呼叫中心的数据.
- 模型验证涉及将模拟数据与现实世界的服务使用季度计数进行比较.
主要成果:
- 目前的系统模拟预测了39,283个初级保健联系人,2,042个紧急 (999) 呼叫和1,120个可以避免的急救人员.
- 为及时获得初级保健服务进行重新配置,增加了196.1%的联系人,但减少了78.0%的999通话和88.1%的急救服务.
- 可避免的ED出勤率平均下降了26个案例.
结论:
- 在模拟模型中确保及时的初级保健联系,大大减少了紧急呼叫和ED访问.
- 需要增加初级保健服务 (将目前的容量几乎增加一倍) 可能是不切实际的.
- 需要进一步研究成本效益和临床/患者可接受性.
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