Abstract
BackgroundAdvanced physiotherapist-led services have been embedded in specialist orthopaedic and neurosurgical outpatient departments across Queensland, Australia, to ameliorate capacity constraints. Simulation modelling has been used to inform the optimal scale and professional mix of services required to match patient demand. The context and the value of simulation modelling in service planning remain unclear. We aimed to examine the adoption, context and costs of using simulation modelling recommendations to inform service planning.MethodsUsing an implementation science approach, we undertook a prospective, qualitative evaluation to assess the use of discrete event simulation modelling recommendations for service re-design and to explore stakeholder perspectives about the role of simulation modelling in service planning. Five orthopaedic and neurosurgical services in Queensland, Australia, were selected to maximise variation in implementation effectiveness. We used the consolidated framework for implementation research (CFIR) to guide the facilitation and analysis of the stakeholder focus group discussions. We conducted a prospective costing analysis in each service to estimate the costs associated with using simulation modelling to inform service planning.ResultsFour of the five services demonstrated adoption by inclusion of modelling recommendations into proposals for service re-design. Four CFIR constructs distinguished and two CFIR constructs did not distinguish between high versus mixed implementation effectiveness. We identified additional constructs that did not map onto CFIR. The mean cost of implementation was AU$34,553 per site (standard deviation = AU$737).ConclusionsTo our knowledge, this is the first time the context of implementing simulation modelling recommendations in a health care setting, using a validated framework, has been examined. Our findings may provide valuable insights to increase the uptake of healthcare modelling recommendations in service planning.
Highlights
Musculoskeletal conditions place an enormous burden on health services in Australia and worldwide [1]
Due to the limited research on the use and implementation of modelling results in healthcare, little is known about the factors that influence the adoption of modelling results to inform service planning
Our findings provide useful insights into how and why decision makers adopt modelling results and its value in healthcare. These findings can be used to inform implementation strategies to increase the use of modelling in service planning
Summary
Musculoskeletal conditions place an enormous burden on health services in Australia and worldwide [1]. Advanced physiotherapist-led models have been embedded in the majority of public orthopaedic and neurosurgical outpatient services across Queensland, Australia, as they have been shown to provide highquality patient care and be cost-effective compared to medical specialist-led models of care in managing orthopaedic demand [4, 5]. Modelling results are used to evaluate the affordability of healthcare interventions and their economic impact on healthcare budgets [9] Simulation modelling, such as discrete event simulation, has been used to support medical (e.g. cost-effectiveness analysis of healthcare interventions) and health policy decisions (e.g. prevention and screening programs, spread of infectious diseases) and has been applied extensively in the area of healthcare operations and system design [10, 11]. We aimed to examine the adoption, context and costs of using simulation modelling recommendations to inform service planning
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