标题： 医疗保健替代支付模式的快速原型模型：复制联邦合格健康中心高级初级护理实践示范 显示英文标题

标题： Rapid Prototyping Model for Healthcare Alternative Payment Models: Replicating the Federally Qualified Health Center Advanced Primary Care Practice Demonstration

摘要： 医疗保健支付和服务交付的创新利用高成本、高风险的试点项目，以及传统的项目评估。 决策者无法可靠预测该复杂系统中试点干预措施的影响，这使得对拟议的医疗保健模式的可行性评估变得复杂。 我们开发并验证了一个针对糖尿病患者的初级护理离散事件模拟（DES）模型，以在试点实施前快速原型设计和评估模型。 我们复制了医疗保险和医疗补助服务中心联邦合格健康中心高级初级护理实践试点的四个结果。 DES模型模拟了一个合成人群的医疗体验，包括症状出现、预约安排、筛查和治疗，以及医生培训的影响。 从同行评审的文献中开发了一个详细的事件模块网络。 合成患者的特点修改了事件输出的概率分布，并引导他们经历一个护理过程；这些特点又会因患者的经历而被修改。 我们的模型复制了医生培训对选定结果的影响方向，且影响强度随着培训次数的增加而增强。 模拟的影响强度复制了试点结果中的眼科检查和肾病筛查结果，但高估了HbA1c和LDL筛查的结果。 我们的模型将提高决策者评估试点成功可行性的能力，具有可重复的、基于文献的系统模型。 我们的模型确定了结果对其敏感的干预和医疗系统组件，因此在试点实施期间可以监测和控制这些方面。 需要更多的工作来改进HbA1c和LDL筛查的复制，并进一步完善与干预组件相关的子模型。 显示英文摘要

摘要： Innovation in healthcare payment and service delivery utilizes high cost, high risk pilots paired with traditional program evaluations. Decision-makers are unable to reliably forecast the impacts of pilot interventions in this complex system, complicating the feasibility assessment of proposed healthcare models. We developed and validated a Discrete Event Simulation (DES) model of primary care for patients with Diabetes to allow rapid prototyping and assessment of models before pilot implementation. We replicated four outcomes from the Centers for Medicare and Medicaid Services Federally Qualified Health Center Advanced Primary Care Practice pilot. The DES model simulates a synthetic population's healthcare experience, including symptom onset, appointment scheduling, screening, and treatment, as well as the impact of physician training. A network of detailed event modules was developed from peer-reviewed literature. Synthetic patients' attributes modify the probability distributions for event outputs and direct them through an episode of care; attributes are in turn modified by patients' experiences. Our model replicates the direction of the effect of physician training on the selected outcomes, and the strength of the effect increases with the number of trainings. The simulated effect strength replicates the pilot results for eye exams and nephropathy screening, but over-estimates results for HbA1c and LDL screening. Our model will improve decision-makers' abilities to assess the feasibility of pilot success, with reproducible, literature-based systems models. Our model identifies intervention and healthcare system components to which outcomes are sensitive, so these aspects can be monitored and controlled during pilot implementation. More work is needed to improve replication of HbA1c and LDL screening, and to elaborate sub-models related to intervention components.