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Geo Data Institute, University of Southampton
Detailed Practical Models
Data Analysis and Modelling
With an emphasis on
Care of People with Particular Diseases and Conditions
and for
Planning and Managing Health Services
Geo Data Institute, University of Southampton
Collaborative work
by
Universities, Industry, and Service Organisations
for
Developing, testing and validating practical detailed models
is
mutually beneficial
Main Messages
Geo Data Institute, University of Southampton
Databases +
Data analysis including classifications +
Detailed models at the level of individual entities=
Powerful tools for making good
Planning and managing decisions
Main Messages
Personal Information
Arjan Shahani
1956 – 1963 Statistician with Philips, London
1964 – 1967 Bristol College of Technology/Bath University
Since 1967 University of Southampton.•Developed Operational Research and collaborative work •Evolved Health work since about 1980.•Set up Institute of Modelling for Healthcare in 1987 in Mathematics Department. •Retired from full-time formal university work in 1998.•Set up Health Data Analysis and Modelling Group in the GeoData Institute, University of Southampton•Health work continues
Geo Data Institute, University of Southampton
Collaborative Work from Southampton • Collaborative work through MSc projects, PhD projects, and Commissioned research projects with many organisations ExamplesDesigning a new sea port for container trafficForecasting milk productionPassenger flows through an airport Interactions between research and production for new products Flows of vegetables through an Indian MarketPlanning for batch production
Care of people with particular diseases
Planning and managing capacities for health services
Health Work At and Through Southampton
Since 1980•Courses on Health work in Southampton MSc OR.
•About 25 PhDs. About 100 MSc Projects.
•About £500K obtained for funding Research Assistants
for work on Health Care and Health Services.
•Research work of the Operational Research Group
awarded Grade 5 in a national UK evaluation exercise in
1996. Health work made a highly significant impact in
this evaluation. OR Group was the only one in Maths
Dept. to be awarded this top Grade.
Geo Data Institute, University of Southampton
Collaborative Health Work
• Collaborative work with many Health professionals and
organisations in UK, Austria, Brazil, India, and Sweden.
Nature of the Southampton Models
• Based on individual patients grouped in appropriate classes.
• Uncertainty and variability are taken into account PROPERLY.
• Models can be easily used by health professionals
Examples
• Care of people with diabetes
• Critical Care capacities
• Whole hospital capacities
Geo Data Institute, University of Southampton
A Program for Classification and Data Analysis
• Rapid extraction of information from databases.
• Patient flows
• Patient outcomes
• Use of resources
• Auditing and monitoring• Links with detailed health care and health services models
• Demonstration of PORT
Health Care Modelling
•Understand and represent the PROCESSES involved in disease, care, patient flows etc.
•Description of community or patient groups. e.g. age, sex, risk groups •Disease history or patient progress
•Interventions e.g. screening, vaccination, treatment, socio- economic actions
•Resources needed or planned
•Costs of resources
Geo Data Institute, University of Southampton
Example of Health Care Modelling
Data Analysis and Modelling
for
Early Detection and Treatment of Breast Cancer
Breast Cancer
Breast cancer is a major form of cancer in many countries.
•In the UK breast cancer results in:•Annually 27,000 new registrations and 15,000 deaths in England and Wales.•20% of all female cancer deaths.•5% of total female deaths.•High mortality in women aged 35-54 years.•In UK women between the ages of 50 and 65 are invited for screening at three-yearly intervals.
Geo Data Institute, University of Southampton
Early Detection of Breast cancer
•Delay in detection can be reduced by screening.
•Apparently healthy women can be screened through:
•Self-examination. •Clinical examination. •X-rays (mammography).
Evidence from many countries suggests that early detection reduces mortality.
Screening using mammography is available in a number of countries.
Cancer starts
Delay indetection
Woman becomes aware Visit to doctor
Treatments start
Time
Geo Data Institute, University of Southampton
Treatment of Breast Cancer
•Many are treatments available.•Treatment depends on the severity of cancer.
Stage I: Small moveable tumour in breast only.
Stage II:Tumour not advanced but spread to lymph nodes.
Stage III:Locally advanced tumour. May be attached to chest muscles.
Stage IV:Distant metastases.
•Mortality rates are the usual measures of goodness of treatment.•Mortality rates vary between hospitals and between countries.•UK mortality rates are high in comparison with Western Europe and
USA.
Modelling
Evaluation without formal cancer models
Mortality Statistics
Intervention Evaluation
Screening or Treatments
eg Randomised Controlled Trial (RCT) for annual mammography
•Noisy data. •Expensive field trials •Information about annual screens •Other options need new RCT
•Cancer models + data from various sources including any necessary RCT is a powerful combination
Geo Data Institute, University of Southampton
Modelling of Screening for Breast Cancer
• Three PhD theses: V de Senna, Y Ouinten, S Mandurah
• Models given to UK Department of Health
• Current UK screening policy was one of the options evaluated by the Southampton Models
Geo Data Institute, University of Southampton
Data and Information for Screening Model
∙Cancer Register ∙Life Tables
∙Population ∙Tumour Growth rate
∙Age of Onset of Cancer ∙Screening Processes
∙Tumour Size ∙Error probabilities
Geo Data Institute, University of Southampton
Screening Model
Inputs to Model Outputs from Model
Particular data sets Tumour size
Expert knowledge Aggressiveness
Screening options Age at detection
eg Starting age Stage of cancer
Intervals % detected by screens
Type of test Resources & costs
Etc
Geo Data Institute, University of Southampton
Illustrative Results From Screening Model
Stage at registration
Non-Screened
319%
113%
260%
48%
2 year Mammography
159%
230%
44%
37%
3 year Mammography
153%2
35%
4 4%3
8%
Geo Data Institute, University of Southampton
Illustrative Results From Screening Model
Tumour doubling time (measure of cancer aggressiveness)
Treatment Model
•Very general model that can be tuned for different users.
•Users define treatment for different stages of cancer, patient progress and treatment outcomes.
Stage 2
Stage 1
Stage 3
Stage 4
Treatment
Treatment
Treatment
DiseaseFree
NoResponse
Response
ProgressiveDisease
Local
Distant
Local andDistant
TreatmentDeathFromBreastCancer
Death FromOther Causes
Illustrative Results From Treatment Model
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Survival Time (Years)
Pro
babi
lity
Stage 1 Stage 2 Stage 3 Stage 4
Survival by stage at diagnosis.
Illustrative Results From Treatment Model
Survival by age at diagnosis.
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Survival Time (Years)
Pro
babi
lity
30-39 40-49 50-59 60-69
Geo Data Institute, University of Southampton
Particular Diseases
Asthma, Breast Cancer, Cataracts,
Cervical Cancer, Chlamydial Infection,
Colorectal Cancer, Depressive Illness,
Diabetes, HIV/AIDS, Trachoma
Some Southampton Health Care Models
Arrival of Individual patient. Patient type. Care Unit needed
Admission rules for Care Units
Required capacities available?
Send elsewhere.Evaluate increased
capacities?
No Yes
Admit Treat Discharge
Health Services Models Capture Patient Flows and Use of Resources
Example: Planning a New Respiratory Unit
Days in a year
No.ofbeds
Proposed capacity of 30 beds
No. of beds in use from a detailed model
Geo Data Institute, University of Southampton
Example:Planning for a Group of Hospitals
• Outpatients, Inpatients, Day cases at four hospitals
• Detailed models at the level of individual patients grouped within about 20 specialities
• Models provided detailed quantitative information about
• The number of beds for each speciality
• The number of operating theatres
• Organisation of outpatient clinics taking the travelling times of the patients into account
Geo Data Institute, University of Southampton
Critical Care Capacities
• Demonstration of a model for planning Critical Care Capacities
• The computer solution of the model is called CCU-SIM
• CCU-SIM can be tuned to represent a particular Critical Care Unit
Comparing Data with Model Predictions
Data Model
Mean
Model 95%
CL for Mean
Emergency Admissions 822 821 814, 828
Elective Admissions 190 191 187, 195
Total Admissions 1012 1012 1004, 1020
Number of Deaths 184 185 182, 188
Bed Occupancy 80.0% 80.3% 79.3%, 81.3%
Deferral rate 20% 21.5% 20.5%, 22.5%
Transfer Rate 1% 1.2% 1.0%, 1.4%
Geo Data Institute, University of Southampton
Distribution of Beds Occupied
• Note evidence of pressure due to heavy use of capacity
Geo Data Institute, University of Southampton
Planning Critical Care Capacities
Evaluation of Scenarios
• Many scenarios involving changes in• Capacities• Case-mix and numbers of patients• Organisation of Critical Care Units
were evaluated
• Some examples will illustrate the use of Southampton models
Increased Demand and Increased Beds
(Base case has 13 beds) Base
Case
14
Beds
16
Beds
Emergency Admissions 822 819 1047
Elective Admissions 190 190 234
Total Admissions 1012 1009 1281
Number of Deaths 184 186 236
Bed Occupancy 80.0% 74.2% 81.8%Deferral rate 20% 12.6% 19.7%
Transfer Rate 1% 0.6% 1.2%
No Neuro Surgery Patients
Geo Data Institute, University of Southampton
Data 13 Beds 12 Beds
Emergency Admissions 770 768 771
Elective Admissions 189 194 190
Total Admissions 959 962 961
Number Died 176 175 179
Bed Occupancy 74.4% 80.8%
Deferral Rate 15.5% 25.3%
Transfer Rate 0.7% 1.3%
20 Extra Planned General Surgery Patients
Geo Data Institute, University of Southampton
Data 13 Beds
14 Beds
Emergency Admissions 822 822 819
Elective Admissions 210 209 212
Total Admissions 1032 1031 1031
Number Died 186 185
Bed Occupancy 81.8% 76.2%
Deferral Rate 23.0% 15.1%
Transfer Rate 1.3% 0.6%
Geo Data Institute, University of Southampton
Hospital Capacities
Demonstration of a model
for
Planning Hospital capacities
Work with Hospitals
Brazil: Through Rio de Janeiro University
India : G.T., Mumbai. KEM, Pune
Sweden: Critical Care (Prof Walther, Dr Steins)
UK: Basingstoke, Bournemouth, Chichester, Dumfries, Heatherwood, Isle of Wight, Norwich, Poole, Princess Anne, Queen Alexandra,
Royal Berkshire, Salisbury, Southampton General, St Marys, Tunbridge, Winchester, + 7 others for Critical Care capacities
Geo Data Institute, University of Southampton
Hospital Capacities: Critical Care Units. A&E + MAU. Hospital Care units. Hospital (existing or new) as a whole.
Outpatient Clinics: Orthopaedics, Depressive illness, ENT, Eye, Skin.
Waiting Lists: Inpatients and Outpatients.
Regional Capacities: Cleft lip and Palate, Coronary, Dental.
Service Provision: Maternity Care.
“Whole System”: Primary Care, Acute Hospital, Post-Acute Care.
Forecasts of daily emergency admissions for hospitals in England. Met Office project
Some Southampton Health Services Models
Geo Data Institute, University of Southampton
Collaborative Work
• MSc projects
Southampton (England) Students June to September Linkoping (Sweden) Students September to December
• PhD / MPhil projects: one to three years
• Research grants
• Commissioned work
• Plan for work with Indian Institutes
Geo Data Institute, University of Southampton
Collaborative Operational Research in Health A Meeting in India
• Indian Health Professionals and Operational Researchers
• Interested people from other countries
• Meeting in January 2007
• Visiting Mumbai, Delhi, Varanasi, Pune, Coimbatore in December 2005 for planning the meeting
Geo Data Institute, University of Southampton
Collaborative Operational Research in Health A Meeting in India
Areas to be covered
• Infectious diseases
• Chronic conditions
• Planning and managing health capacities
• Indian System of Medicine (Ayurveda)
• Combining Indian and “Western” Systems of Medicine
Geo Data Institute, University of Southampton
Contact Details
Dr Arjan Shahani,
Director,
Health Data Analysis and Modelling Group,
GeoData Institute,
University of Southampton, Southampton SO15 7PJ
Email to hotmail address with copies to
geodata and maths addresses please