Optimizing Home Hospital Health Service Delivery in Norway Using a Combined Geographical Information System, Agent Based, Discrete Event Simulation Model

Home hospital services; provide some hospital level services at the patient’s residence. The services include for example: palliative care, administering chemotherapy drugs, changing dressings and care for newborns. The rationale of the service is that by providing high quality care to patients at their homes their experience of the care is better and hence they respond to the treatment and/or recover quicker and are less likely to need to report to hospital to receive care for more serious/expensive conditions. The aim of this study is to evaluate the effectiveness of the home hospital service, to optimize the current configuration given existing constraints and to evaluate potential future scenarios. Using a combined discrete event simulation, agent based model and geographical information system we assess the system effects of different demand patterns, appointment scheduling algorithms (e.g. travelling salesman problem), varying levels of resource on patient outcomes and impact on hospital visits.

A hybrid simulation model consisting of agent based models (Law 2014; Noble et al. 2012) and discrete event simulation (Zeigler et al. 2000) models is being developed to assess the delivery of advanced home hospital services (AHHS) in Norway. These types of service are also known as home hospital services (HHS), and are referred to as “avansert hjemmesykehus” (AHS) advanced home hospitals in Norway. This paper presents the model as it currently stands with some preliminary results and reflections thus far.

This project is part of the Centre for Connected Care (C3), research Centre funded through the Norwegian Research Council to investigate the acceleration and adoption of innovation between industrial, health and academic partners relating to healthcare.

The next section will provide a brief overview of AHS and specifically from a Norwegian perspective. Additionally summary data will be presented before discussing the model development in section 3. Early results shall be presented in section 4. The paper will conclude with a discussion focusing on modelling steps, data collection and validation, scenario elicitation and thoughts on future directions.

Home hospital services

Demand for hospital services is increasing rapidly due to ageing populations and advances in the treatment of previously untreatable conditions and disease. AHS have gained traction over the last 20 years due to increases in medical knowledge and improvements in medical technology. AHS is a popular response to the increasing demand for acute hospital beds. Cutting costs by avoiding admission to hospital, and reducing hospital length of stay are central goals of such schemes. However, it is not known if patients admitted to hospital at home have better or equivalent health outcomes compared with patients receiving in-patient hospital care. Nor is it known if the provision of hospital at home results in a reduction, or increase, in costs to the health service. (Shepperd et al. 1998).

There are numerous definitions of home hospital services, due to the type and complexity of service(s) provided. Additionally differences can be attributed to variations in health care delivery by country. Other definitions of home hospital services are provided by (Thome et al. 2003; Jeppseesen et al. 2012; Parab et al. 2013; Varney et al. 2014; Sheperd et al. 2016; Park et al. 2013).

The beginning of modelling work: summarized data

Number of patients and visits, per week from December 2015 until August 2016.

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