实施模拟建模以改善骨科和神经外科专科门诊服务的规划。
Implementation of simulation modelling to improve service planning in specialist orthopaedic and neurosurgical outpatient services.
机构信息
Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital campus, Woolloongabba, Queensland, 4102, Australia.
Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Queensland, 4029, Australia.
出版信息
Implement Sci. 2019 Aug 9;14(1):78. doi: 10.1186/s13012-019-0923-1.
BACKGROUND
Advanced physiotherapist-led services have been embedded in specialist orthopaedic and neurosurgical outpatient departments across Queensland, Australia, to ameliorate capacity constraints. Simulation modelling has been used to inform the optimal scale and professional mix of services required to match patient demand. The context and the value of simulation modelling in service planning remain unclear. We aimed to examine the adoption, context and costs of using simulation modelling recommendations to inform service planning.
METHODS
Using an implementation science approach, we undertook a prospective, qualitative evaluation to assess the use of discrete event simulation modelling recommendations for service re-design and to explore stakeholder perspectives about the role of simulation modelling in service planning. Five orthopaedic and neurosurgical services in Queensland, Australia, were selected to maximise variation in implementation effectiveness. We used the consolidated framework for implementation research (CFIR) to guide the facilitation and analysis of the stakeholder focus group discussions. We conducted a prospective costing analysis in each service to estimate the costs associated with using simulation modelling to inform service planning.
RESULTS
Four of the five services demonstrated adoption by inclusion of modelling recommendations into proposals for service re-design. Four CFIR constructs distinguished and two CFIR constructs did not distinguish between high versus mixed implementation effectiveness. We identified additional constructs that did not map onto CFIR. The mean cost of implementation was AU$34,553 per site (standard deviation = AU$737).
CONCLUSIONS
To our knowledge, this is the first time the context of implementing simulation modelling recommendations in a health care setting, using a validated framework, has been examined. Our findings may provide valuable insights to increase the uptake of healthcare modelling recommendations in service planning.
背景
在澳大利亚昆士兰州，高级物理治疗师主导的服务已经嵌入到专门的骨科和神经外科门诊部门，以缓解能力限制。模拟建模已被用于为匹配患者需求所需的服务的最佳规模和专业组合提供信息。模拟建模在服务规划中的背景和价值仍然不清楚。我们旨在研究采用、背景和使用模拟建模建议来为服务规划提供信息的成本。
方法
我们采用实施科学方法，进行了一项前瞻性的定性评估，以评估使用离散事件模拟建模建议进行服务重新设计的情况，并探讨利益相关者对模拟建模在服务规划中的作用的看法。在澳大利亚昆士兰州选择了五个骨科和神经外科服务，以最大限度地增加实施效果的变异性。我们使用实施研究的综合框架（CFIR）来指导利益相关者焦点小组讨论的促进和分析。我们在每个服务中进行了前瞻性的成本分析，以估计使用模拟建模为服务规划提供信息的相关成本。
结果
五个服务中有四个服务展示了采用，将建模建议纳入服务重新设计提案中。四个 CFIR 结构区分了高实施效果和混合实施效果，而两个 CFIR 结构则没有区分。我们确定了其他与 CFIR 不相关的结构。实施的平均成本为每个地点 34553 澳元（标准差=737 澳元）。
结论
据我们所知，这是首次使用经过验证的框架检查在医疗保健环境中实施模拟建模建议的背景。我们的发现可能为提高医疗保健建模建议在服务规划中的采用提供有价值的见解。
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