The Need for Systems Tools in the Practice of Clinical Medicine

McGovern

2020

Syst Res Behav Sci

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Psychiatric and substance use disorders, such as depression and/or opioid use disorders, are categorized as behavioural health conditions. In the United States, approximately one in four adults suffers from a behavioural health condition in any given year. These conditions are prevalent and costly. The current delivery of behavioural health services follows a primary to specialty referral practice, which has led to poor treatment initiation outcomes. These poor outcomes stem from a care delivery model that does not fully cater to the needs of patients. Patients prefer to receive both physical and mental health care within a single primary care setting. In response, healthcare delivery systems developed clinical models and approaches for behavioural health integration into primary care. These clinical models portray a sense of integration. However, these clinical models lack the necessary detail to describe the key components of a system and instead focus heavily on describing the system's physical form. By doing so, clinical models lack the ability to incorporate a broader range of patient needs and the details to describe a system to ensure it produces its intended outcomes. These limitations lead to variations in implementation success. Systematic approaches, including the development of system models, have been used to describe and develop complex systems. In this paper, we detail the design considerations for a patient‐centred system model and describe its utilization in an implementation of a patient‐centered behavioural health integration into primary care.

Section: Resultsmentioning

confidence: 99%

Implementing Patient‐Centred Behavioural Health Integration into Primary Care Using Model‐Based Systems Engineering

McGovern

2020

Syst Res Behav Sci

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“…Systems thinking and systems engineering methods and tools have been used as exemplars across the health field. This section, however, focuses on the fields that have emerged that draw significantly from systems thinking [26]. These include Systems Biology and Healthcare Systems Engineering.…”

Section: Domains Applying Systems Thinking To the Health Fieldmentioning

confidence: 99%

A Systems Thinking Approach to Designing Clinical Models and Healthcare Services

2019

Systems

Chronic diseases are on the rise, increasing in number and treatment regimen complexity. Consequently, the needs of patients with chronic diseases are increasing and becoming more complex and multi-faceted. Such chronic conditions require addressing not only the physical body, but also psychosocial and spiritual health. The healthcare delivery system, however, organically organized into departments based on physical organ systems. Such a configuration makes it ill-suited to provide comprehensive multi-faceted healthcare services that span multiple departments and specialties (e.g., podiatry and endocrinology for diabetes; primary care and psychiatry for behavioral health; and palliative care physicians, chaplains, and social workers for end-of-life care). To deliver new services, the medical field typically designs new clinical models to base its new services on. Several challenges arise from typical approaches to designing healthcare services and clinical models, including addressing only single conditions, describing models only at a high-level of abstraction, and using primarily narrative documents called text-based toolkits for implementation. This paper presents and uses systems thinking as an alternative strategy to designing clinical system models and healthcare services to alleviate many of the current design challenges in designing integrated services for chronic conditions. An illustrative example taking a clinical model and describing it as a system model is presented.

“…The second Petri net is called the Health Net. It describes the 'clinical' health state evolution of individuals in Section III-C. As discussed in detail previously [45], although the human body's health state evolves continuously via biological processes, the practice of clinical medicine discretizes this evolution into discrete states so as to…”

Section: Definition 13 Structural Degrees Of Freedommentioning

confidence: 99%

Architecting a System Model for Personalized Healthcare Delivery and Managed Individual Health Outcomes

Farid

2018

Complexity

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The current healthcare system is facing an unprecedented chronic disease burden. This paper develops a healthcare dynamic model for personalized healthcare delivery and managed individual health outcomes. It utilizes a hetero-functional graph theory rooted in Axiomatic Design for Large Flexible Engineering Systems and Petri nets. The dynamics of the model builds upon a recently developed systems architecture for healthcare delivery which bears several analogies to the architecture of masscustomized production systems. At its essence, the model consists of two synchronized Petri nets; one for the healthcare delivery system and another for individuals' health state evolution. The model is demonstrated on two clinical case studies; one acute and another chronic. Together, the case studies show that the model applies equally to the care of both acute and chronic conditions, transparently describes health outcomes and links them to the evolution of the healthcare delivery system and its associated costs. Index Terms-systems framework; dynamic model healthcare delivery system; personalized care; individual health outcomes; arXiv:1910.09104v1 [eess.SY]