Li Yan, Padrón Norma A, Mangla Anil T, Russo Pamela G, Schlenker Thomas, Pagán José A
1 Center for Health Innovation, The New York Academy of Medicine, New York, NY, USA.
2 Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Public Health Rep. 2017 Sep/Oct;132(5):549-555. doi: 10.1177/0033354917722149. Epub 2017 Aug 16.
Because of state and federal health care reform, local health departments play an increasingly prominent role leading and coordinating disease prevention programs in the United States. This case study shows how a local health department working in chronic disease prevention and management can use systems science and evidence-based decision making to inform program selection, implementation, and assessment; enhance engagement with local health systems and organizations; and possibly optimize health care delivery and population health.
The authors built a systems-science agent-based simulation model of diabetes progression for the San Antonio Metropolitan Health District, a local health department, to simulate health and cost outcomes for the population of San Antonio for a 20-year period (2015-2034) using 2 scenarios: 1 in which hemoglobin A1c (HbA1c) values for a population were similar to the current distribution of values in San Antonio, and the other with a hypothetical 1-percentage-point reduction in HbA1c values.
They projected that a 1-percentage-point reduction in HbA1c would lead to a decrease in the 20-year prevalence of end-stage renal disease from 1.7% to 0.9%, lower extremity amputation from 4.6% to 2.9%, blindness from 15.1% to 10.7%, myocardial infarction from 23.8% to 17.9%, and stroke from 9.8% to 7.2%. They estimated annual direct medical cost savings (in 2015 US dollars) from reducing HbA1c by 1 percentage point ranging from $6842 (myocardial infarction) to $39 800 (end-stage renal disease) for each averted case of diabetes complications.
Local health departments could benefit from the use of systems science and evidence-based decision making to estimate public health program effectiveness and costs, calculate return on investment, and develop a business case for adopting programs.
由于州和联邦层面的医疗保健改革，美国地方卫生部门在引领和协调疾病预防项目方面发挥着日益突出的作用。本案例研究展示了一个从事慢性病预防与管理工作的地方卫生部门如何运用系统科学和循证决策来为项目选择、实施及评估提供依据；加强与地方卫生系统及组织的合作；并有可能优化医疗服务提供及人群健康状况。
作者为圣安东尼奥市大都会卫生区（一个地方卫生部门）构建了一个基于系统科学的、以主体为基础的糖尿病病情进展模拟模型，以模拟圣安东尼奥市人群在20年期间（2015 - 2034年）的健康和成本结果，采用两种情景：一种情景是人群的糖化血红蛋白（HbA1c）值与圣安东尼奥市当前的值分布相似，另一种情景是HbA1c值假设降低1个百分点。
他们预计HbA1c降低1个百分点将使20年内终末期肾病的患病率从1.7%降至0.9%，下肢截肢率从4.6%降至2.9%，失明率从15.1%降至10.7%，心肌梗死率从23.8%降至17.9%，中风率从9.8%降至7.2%。他们估计，每避免一例糖尿病并发症，将HbA1c降低1个百分点每年可节省的直接医疗成本（以2015年美元计）从6842美元（心肌梗死）到39800美元（终末期肾病）不等。
地方卫生部门可通过运用系统科学和循证决策来估计公共卫生项目的有效性和成本、计算投资回报率并为采用项目制定商业案例而受益。
