Abstract
Chronic care is an important area for cost-effective and efficient health service delivery. Matching demand and services for chronic care is not easy as patients may have different needs in different stages of the disease. More insight is needed into the complete patient journey to do justice to the services required in each stage of the disease, to the different experiences of patients in each part of the journey, and to outcomes in each stage. With patient journey we refer to the “journey” of the patient along the services received within a demand segment of chronic care. We developed a generic framework for describing patient journeys and provider networks, based on an extension of the well-known model of Donabedian, to relate demand, services, resources, behavior, and outcomes. We also developed a generic operational model for the detailed modeling of services and resources, allowing for insight into costs. The generic operational model can be tailored to the specific characteristics of patient groups. We applied this modeling approach to type 2 diabetes (T2D) patients. Diabetes care is a form of chronic care for patients suffering diabetes mellitus. We studied the performance of T2D networks, using a descriptive model template. To identify and describe demand we made use of the following demand segments within the diabetes type 2 population: patients targeted for prevention; patients with stage 1 diabetes treated by their GP with lifestyle advice; patients with diabetes stage 2 treated by their GP with lifestyle advice and oral medication; patients with stage 3 diabetes treated by their GP with lifestyle advice, oral medication, and insulin injections; patients with stage 4 diabetes with complications (treated by internal medicine specialists). We used a Markov model to describe the transitions between the different health states. The model enables the patient journey through the health care system for cohorts of newly diagnosed T2D patients to be described, and to make a projection of the resource requirements of the different demand segments over the years. We illustrate our approach with a case study on a T2D care network in The Netherlands and reflect on the role of demand segmentation to analyse the case study results, with the objective of improving the T2D service delivery.
Highlights
Demand for health services is increasing due to a growing and aging population, putting access, and healthcare expenditures under pressure [1]
The research questions addressed in this paper are: How can we model the chronic condition patient journey in sufficient detail to be able to account for different needs, treatments, and outcomes relevant in different stages of the disease, and for different patient subpopulations? What are the results of applying demand segmentation to diabetes type 2 patients?
In this paper we investigated how we can model the patient journey of patients with a chronic condition, and to address different needs, treatments, and outcomes, as relevant in different stages of the condition, and for different subpopulations with the condition
Summary
Demand for health services is increasing due to a growing and aging population, putting access, and healthcare expenditures under pressure [1]. The increasing prevalence of chronic diseases in particular makes longer term health service delivery arrangements an important area for enhancing cost-effectiveness and efficiency. Insight into the resources correspondingly required is a crucial prerequisite to tackle these challenges in delivering health care [2]. The variety of needs over different stages of chronic illness means that management and tailoring of health services is a complex task. This applies, for instance, to many patients with highly prevalent chronic conditions such as diabetes, COPD, and stroke. Models within the realm of the Chronic Care Model [3] often lack detail in process description and corresponding resource requirements which are key to determining service costs and effectiveness
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