Contents. About the authors

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1 Contents About the authors Glossary Prologue References xi xiii xvii xxii Part I Modeling and simulation framework for value-based healthcare systems 1 1 Healthcare systems modeling and simulation Review of healthcare systems simulation Levels of care Contextual challenges Care objectives Observed abstractions Measured/computed outcomes Modeling approaches Simulation techniques Browsing the web of contributions Lessons learnt in a nutshell Ontology for healthcare systems simulation Ontology in M&S Ontology in healthcare M&S System entity structure ontological framework Ontology for healthcare systems simulation Model base for healthcare systems M&S Summary 35 References 36 2 Multi-perspective architecture for holistic healthcare M&S Multi-perspective modeling of healthcare systems Health diffusion models Resource allocation models Individual behavior models Population dynamics models Analysis of a hospital home care service delivery model Holistic healthcare systems M&S Aggregation and disaggregation 71

2 vi Value-based learning healthcare systems Dynamic change of structure Summary 72 References 73 3 Formalization of the multi-perspective architecture Conceptual foundations Formal foundations DEVS specification of atomic and coupled models Parameterized DEVS DEVS-specified multi-perspective healthcare system model Illustrative case Ebola spreading model Hospital beds allocation model Interstate migrations model Daily worker model Integrators Holistic model Introduction to pathways-based coordination Summary 105 References Methodological elements for simulation-based healthcare management Scale-driven modeling HiLLS modeling Multi-paradigm modeling Participatory modeling M&S knowledge Knowledge management for MPM&HS Summary 124 References 127 Part II Modeling and simulation of pathways-based care coordination DEVS methodology for coordination modeling Introduction Overview of DEVS methodology for coordination modeling Healthcare as a learning collaborative system of systems Care coordination Pathways-based care coordination Coordination of cross-system transactions Pathways as coordination models Atomic pathways models Coupled pathways models Quality of service measurement 144

3 Contents vii Porter s integrated practice unit Formal representation for care delivery value chain Pathways-based outcome measurement Pathways-based cost measurement for value-based purchasing Alternative component configurations Example: coordinated HIV AIDS care system model Pathways-based learning system implementation Activity-based credit assignment applied to HIV AIDS example Relations to current research Summary 157 References Care coordination and pathways-based experimental frames Introduction Background: origins of the pathways model Review: formulating and defining pathways Pathway concept Pathway: initiation, action, completion, and closure steps Example: pregnancy pathway Initialization checklists Formalization of pathways Atomic model representation Experimental frames for pathway simulation Metrics for quality of reporting Consistency of reporting Completeness metrics Adherence metrics Exemplary data analysis Consistency and adherence Pregnancy pathway closure and completeness Reporting competence analysis Client adherence analysis Health outcome metrics Pathway-based systems operational metrics Pathway activity distribution Pathway-duration distribution Temporal metrics Summary 180 References Pathways-based care coordination simulation example Introduction Simulation model framework Evaluation framework for coordinated care architectures Pathways home care coordination in low birth weight prevention 185

4 viii Value-based learning healthcare systems Model description Return on investment Sustainability The model as an exemplar of value-based HDSoS Conclusions and recommendations 191 References 191 Appendix A 193 A.1 Ms4 Me code and graphical displays for the CHAP ROI model Health information technology support for pathways-based care Introduction Requirements for pathways-based web portal Temporal requirements Implementation approaches Ontology to include care coordination in UMLS Implications for EHR systems and care coordination in general Conclusions and recommendations 210 References 211 Part III Application of the framework Pathways-based coordination of care in rural France Introduction Problem statement Case model Physicians distribution Population Care pathways Management rules Patient s satisfaction General overview of the proposed architecture Patient behavior and connection to multilayer network Class diagram of the architecture XmlManager behavior Scenarios and simulation results Conclusion and perspectives 236 References 237 Appendix B 240 B.1 Architecture modeling and simulation of propagation phenomena 240 B.2 Background and general architecture 240 B.2.1 Context 240 B.2.2 General architecture 240 B.3 Population generation for network simulation 241 B.3.1 General presentation 241 B.3.2 Dimensions and algorithms 241

5 Contents ix B.3.3 Nodes 242 B.3.4 The family dimension 242 B.4 Conclusion 244 B.5 Simulation of information propagation module: simulation 244 B.5.1 Operational modeling agent 244 B.5.2 Representation of agent behavior 245 B.5.3 Simulation environment 246 B.6 Conclusion 249 References Surveillance of avian influenza in Vietnam Context Method Problem Actors and resources Interactions Dynamics Implementation and simulation of the model Relation to the methodology developed Chapter Results Problem Actors and interactions Dynamics Implementation Conclusion 264 References Multi-perspective modeling in relation to complex adaptive systems Background on complex adaptive systems and systems of systems Fundamental requirements for M&S of complex adaptive systems and SoS Deal with system-of-systems (SoS) M&S nature Develop an organizational ontology for M&S-based applications Enable the ontology to support combinatorial model compositions Include the major facets at the top level to ensure macro behavior Include a large spectrum of models for combinatorial composition Instrument the system to support continuous on-going high-quality data Include pervasive incremental automated learning Summary 272 References 274

6 x Value-based learning healthcare systems Appendix C 275 C.1 Case study of machine learning based assignment of pathways in care coordination Extending the framework to value-based coordination architectures Introduction Alternative payment models Model construction methodology The crucial role of system-level integration Personal limitation models Family of models approach Model decomposition and hierarchical design Top-down design Level specification Summary 288 References 289 Epilogue: Where do we go from here Global and National Healthcare Maturity 291 E.1 Health system capability maturity 291 E.2 Health system performance 294 E.3 Model development and application under the multi-perspective modeling framework 298 E.4 Open research 300 References 302 Appendix D1 304 D1.1 Formalizing Porter s integrated practice unit with system of systems modeling and simulation 304 Appendix D2 310 D2.1 Pathways-based client engagement support 310 Appendix D3 316 D3.1 Measuring health outcomes: the outcome hierarchy 316 Conclusion 333 References 334 Appendix D4 335 D4.1 Generic framework to Multi-Perspective Modeling and Holistic Simulation 335 Index 339

A FORMALIZATION AND EXTENSION OF THE PURDUE ENTERPRISE REFERENCE ARCHITECTURE AND THE PURDUE METHODOLOGY REPORT NUMBER 158

A FORMALIZATION AND EXTENSION OF THE PURDUE ENTERPRISE REFERENCE ARCHITECTURE AND THE PURDUE METHODOLOGY REPORT NUMBER 158 Purdue Laboratory for Applied Industrial Control Prepared by Hong Li Theodore