Examining the effect of interventions in emergency care for older people using a system dynamics decision support tool

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• dc.contributor.author England, Tracey
• dc.contributor.author Brailsford, Sally
• dc.contributor.author Evenden, Dave
• dc.contributor.author Street, Andrew
• dc.contributor.author Maynou Pujolràs, Laia
• dc.contributor.author Mason, Suzanne M.
• dc.contributor.author Preston, Louise
• dc.contributor.author Burton, Christopher
• dc.contributor.author van Oppen, James
• dc.contributor.author Conroy, Simon
• dc.date.accessioned 2023-06-26T05:55:55Z
• dc.date.available 2023-06-26T05:55:55Z
• dc.date.issued 2023
• dc.description.abstract Background: Rising demand for Emergency and Urgent Care is a major international issue and outcomes for older people remain sub-optimal. Embarking upon large-scale service development is costly in terms of time, energy and resources with no guarantee of improved outcomes; computer simulation modelling offers an alternative, low risk and lower cost approach to explore possible interventions. Method: A system dynamics computer simulation model was developed as a decision support tool for service planners. The model represents patient flow through the emergency care process from the point of calling for help through ED attendance, possible admission, and discharge or death. The model was validated against five different evidence-based interventions (geriatric emergency medicine, front door frailty, hospital at home, proactive care and acute frailty units) on patient outcomes such as hospital-related mortality, readmission and length of stay. Results: The model output estimations are consistent with empirical evidence. Each intervention has different levels of effect on patient outcomes. Most of the interventions show potential reductions in hospital admissions, readmissions and hospitalrelated deaths. Conclusions: System dynamics modelling can be used to support decisions on which emergency care interventions to implement to improve outcomes for older people.
• dc.description.sponsorship This work was supported by the NIHR, grant number (17/05/96), Identifying models of care to improve outcomes for older people with emergency and urgent care needs—funding applies to S.C., T.E., S.B., C.B., S.M.M., L.P., D.E., A.S., L.M.. S.C. and J.V.O. were also funded under NIHR Doctoral Research Fellowship 300901, 2020–2023, The development and validation of a patient-reported outcome measure for older people with frailty and urgent care needs. L.P. also receives(d) funding to undertake evidence reviews across the HS&DR and PHR programmes for NIHR. T.E. also received funding from the University of Southampton to further disseminate the decision support tool through a series of workshops to members of the British Geriatrics Society (BGS) community. L.M. is also funded by the Spanish Ministry of Science, Innovation and Universities (PID2019-104319RB-I00). S.C. is paid as clinical lead for the Acute Frailty Network, a national frailty improvement collaborative (NHS Elect), and receives research funding from NIHR for work on urgent care for older people. S.B. and T.E. received funding from NIHR for work on Frailty Dynamics.
• dc.format.mimetype application/pdf
• dc.identifier.citation England T, Brailsford S, Evenden D, Street A, Maynou L, Mason SM, Preston L, Burton C, Van Oppen J, Conroy S. Examining the effect of interventions in emergency care for older people using a system dynamics decision support tool. Age Ageing. 2023;52(1):afac336. DOI: 10.1093/ageing/afac336
• dc.identifier.doi http://dx.doi.org/10.1093/ageing/afac336
• dc.identifier.issn 0002-0729
• dc.identifier.uri http://hdl.handle.net/10230/57323
• dc.language.iso eng
• dc.publisher Oxford University Press
• dc.relation.ispartof Age and Ageing. 2023;52(1):afac336.
• dc.relation.projectID info:eu-repo/grantAgreement/ES/2PE/PID2019-104319RB-I00
• dc.rights © The Author(s) 2022. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
• dc.subject.keyword frailty
• dc.subject.keyword emergency and urgent care
• dc.subject.keyword interventions
• dc.subject.keyword system dynamics
• dc.subject.keyword older people
• dc.title Examining the effect of interventions in emergency care for older people using a system dynamics decision support tool
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion