Institute of Health Care Engineering, Graz University of Technology, Stremayrgasse 16/II, 8010, Graz, Austria.
Steiermärkische Krankenanstaltengesellschaft m.b.H. (KAGes), Stiftingtalstraße 4-6, 8010, Graz, Austria.
BMC Med Inform Decis Mak. 2019 Nov 21;19(1):229. doi: 10.1186/s12911-019-0944-3.
Demographic changes, increased life expectancy and the associated rise in chronic diseases pose challenges to public health care systems. Optimized treatment methods and integrated concepts of care are potential solutions to overcome increasing financial burdens and improve quality of care. In this context modeling is a powerful tool to evaluate potential benefits of different treatment procedures on health outcomes as well as health care budgets. This work presents a novel modeling approach for simulating different treatment procedures of heart failure patients based on extensive data sets from outpatient and inpatient care.
Our hybrid heart failure model is based on discrete event and agent based methodologies and facilitates the incorporation of different therapeutic procedures for outpatient and inpatient care on patient individual level. The state of health is modeled with the functional classification of the New York Heart Association (NYHA), strongly affecting discrete state transition probabilities alongside age and gender. Cooperation with Austrian health care and health insurance providers allowed the realization of a detailed model structure based on clinical data of more than 25,000 patients.
Simulation results of conventional care and a telemonitoring program underline the unfavorable prognosis for heart failure and reveal the correlation of NYHA classes with health and economic outcomes. Average expenses for the treatment of NYHA class IV patients of €10,077 ± €165 were more than doubled compared to other classes. The selected use case of a telemonitoring program demonstrated potential cost savings within two years of application. NYHA classes II and III revealed most potential for additional treatment measures.
The presented model allows performing extensive simulations of established treatment procedures for heart failure patients and evaluating new holistic methods of care and innovative study designs. This approach offers health care providers a unique, adaptable and comprehensive tool for decision making in the complex and socioeconomically challenging field of cardiovascular diseases.
人口结构变化、预期寿命延长以及由此导致的慢性疾病增加，给公共医疗保健系统带来了挑战。优化的治疗方法和综合护理理念是克服不断增加的财务负担和提高护理质量的潜在解决方案。在这种情况下，建模是评估不同治疗方法对健康结果和医疗保健预算潜在影响的有力工具。本研究提出了一种新的建模方法，用于模拟心力衰竭患者的不同治疗方法，该方法基于门诊和住院护理的广泛数据集。
我们的混合心力衰竭模型基于离散事件和基于代理的方法，能够在患者个体层面上纳入门诊和住院治疗的不同治疗程序。健康状况采用纽约心脏协会（NYHA）的功能分类进行建模，强烈影响离散状态转移概率，同时还受年龄和性别影响。与奥地利医疗保健和医疗保险提供商的合作使得能够根据超过 25000 名患者的临床数据实现详细的模型结构。
常规护理和远程监测计划的模拟结果突显了心力衰竭的不利预后，并揭示了 NYHA 分级与健康和经济结果之间的相关性。与其他分级相比，NYHA 分级 IV 患者的治疗费用平均为 10077 欧元±165 欧元，增加了一倍多。选择远程监测计划的用例表明，在应用两年内可能会节省成本。NYHA 分级 II 和 III 显示出对额外治疗措施的最大潜力。
所提出的模型允许对心力衰竭患者的既定治疗程序进行广泛模拟，并评估新的整体护理方法和创新的研究设计。这种方法为医疗保健提供者提供了一个独特、适应性强且全面的决策工具，用于处理心血管疾病这一复杂且具有社会经济挑战性的领域。
