Resumen de Application of discrete-event simulation to health services research: analysis of needs and demand for elective surgery
Merce Comas Serrano
Computer simulation techniques have allowed the introduction of modeling methodologies that analyze complex systems through virtual experimentation to assess the potential impact of interventions on health services, Discreteevent simulation is a well-known technique in operations research, and has mainly been developed in the context of military research and manufacturing systems. In the medical setting, Markov models and decision trees have been extensively used despite their limitations in reproducing healthcare problems accurately. Discrete-event simulation is gaining popularity because of its flexibility in representing real systems by taking into account patient characteristics and the scarcity of resources present in health services provision. This technique has been used to analyze problems related to healthcare resource management, but its possibilities to analyze larger problems related to population dynamics have been hardly explored. Traditionally, needs and demand for health services have been analyzed separately. In the present application, the response of the health system to both the population with need for surgery and to the patients included on a waiting list was analyzed.
In this sense, the main contribution of this thesis is the application of discrete-event simulation to health services research from an epidemiologic point of view. Moreover, the model was statistically complex because the variety of sources and characteristics of data defining the main inputs and rules of the modeled system asked for a specific ad hoc methodology to collect and process them to generate the inputs that the simulation model needs. Therefore a relevant part of this work has been devoted to develop such input data analysis methodology.
A discrete-event simulation model was built for needs and demand for cataract surgery in the Catalan public sector. The model reproduced the process of cataract surgery, from incidence of need for surgery, through demand, inclusion
