Primary Healthcare Delivery Network Simulation Using Stochastic Metamodels

Abstract

A discrete-event simulation (DES) of the network of primary health centers (PHCs) in a region can be used to evaluate the effect of changes in patient flow on operational outcomes across the network, and can also form the base simulation to which simulations of secondary and tertiary care facilities can be added. We present a DES of a network of PHCs using stochastic metamodels developed from more detailed DES models of PHCs ('parent' simulations), which were developed separately for comprehensively analyzing individual PHC operations. The stochastic metamodels are DESs in their own right. They are simplified versions of the parent simulation with full-featured representations of only those components relevant to the analysis at hand. We show that the outputs of interest from the metamodels and the parent simulations (including the network simulations) are statistically similar and that our metamodel-based network simulation yields reductions of up to 80% in runtimes.

Simulation modeling and analysis of primary health center operations

“…Simulations of the network of PHCs in a region can be used for many types of operational analyses associated with policy changes in healthcare administration in the region. For example, Fatma and Ramamohan 65 utilize the PHC models presented in this paper to develop a simulation of the network of PHCs in the district under consideration. Afterward, they demonstrated how the issue of increased wait times before admission to the childbirth facility in a PHC could be alleviated by diverting patients based on real-time predictions of their wait times generated at the time childbirth patients arrive at the PHC seeking admission.…”

“…In contrast, the creation of simulation models of configurations 2 and 3 represent full model reuse in the same setting and for the same purpose (analysis of PHC operations). For example, in Fatma and Ramamohan, 65 a real-time delay prediction and diversion module was added to the PHC models that we present here, and in the latter study described above, COVID-19 testing and triaging pathways were added. These modified individual PHC models were then integrated into the network of public health facilities within the district.…”

“…The notion of simulation model reuse was explored – albeit very briefly – in the context of generic modeling by Fletcher and Worthington 57 and in detail by Robinson et al 54 Robinson et al 54 postulate a spectrum of model reuse, with the following key types: code segment reuse, function reuse, model component reuse, and full model reuse. They also note that reuse of a model may be done for similar purposes as the original instance (e.g., a generic PHC model developed for broad-based operational analysis may be adapted to model and analyze operations of a specific PHC encountered in a different location), or for a different purpose (e.g., to simulate implementation of patient referral or diversion mechanisms across a network of PHCs as in Fatma and Ramamohan 65 ). Note that model reuse – in particular, component and full model reuse – does not necessarily imply reuse completely devoid of modification.…”

“…14 Therefore, in this study, we focus on developing discrete-event simulation (DES) models of PHC operations as part of an ongoing effort to establish the computational infrastructure required to model and analyze public health operations in the Indian context. 15 Our approach toward modeling and analyzing PHC operations can provide researchers and analysts in other countries with similar hierarchical public health systems with a template for developing models of similar primary/secondary healthcare facilities in their contexts. For example, the Ghanaian public healthcare system consists of five tiers (similar to the Indian system when SCs and superspecialty hospitals are also considered), with their “subdistrict” health centers being the equivalent of the Indian PHCs.…”

Outpatient Diversion using Real-Time Length-of-Stay Predictions

“…The Indian government has recently undertaken an initiative to expand and upgrade existing primary health centers (PHCs) (Blanchard et al, 2021), and hence it is reasonable to assume an increase in the patient load at these PHCs given the established link between increased quality of care, improved infrastructure and higher demand (Rao and Sheffel, 2018). Based on previous work regarding modelling PHC operations (Fatma et al, 2020;Shoaib and Ramamohan, 2021), we developed a discrete-event simulation (DES) of medical care operations of two PHCs in an Indian district. Under conditions of high outpatient demand, the DES outcomes indicated signifcant disparity in outpatient LOSs across both facilities, and this would likely extend to the entire public health network in the district.…”