A multi-phase DES modelling framework for patient-centred care

We provide a framework for simulating the entire patient journey across different phases (such as diagnosis, treatment, rehabilitation and long-term care) and different sectors (such as GP, hospital, social and community services), with the aim of providing better understanding of such processes and facilitating evaluation of alternative clinical and care strategies. A phase-type modelling approach is used to promote better modelling and management of the specific elements of a patient pathway, using performance measures such as clinical outcomes, patient quality of life, and cost. The approach is illustrated using stroke disease. Approximately 5% of the United Kingdom National Health Service budget is spent treating stroke disease each year. There is an urgent need to assess whether existing services are cost-effective or new interventions could increase efficiency. This assessment can be made using models across primary and secondary care; in particular we evaluate the cost-effectiveness of thrombolysis (clot busting therapy), using discrete event simulation. Using our model, patient quality of life and the costs of thrombolysis are compared under different regimes. In addition, our simulation framework is used to illustrate the impact of internal discharge queues, which can develop while patients are awaiting placement. Probabilistic Sensitivity Analysis of the value parameters is also carried out.