Modeling Prioritization of Health Care for Complex Patients Using Archimedes

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Complex Patients Require Complex Treatments. Optimize TreatmentThere are many interventions; which should be done first? Diminishing ReturnsHow many interventions is too many?Optimizing Prevention and Healthcare Management for the Complex Patient FOA . Diabetes

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Modeling Prioritization of Health Care for Complex Patients Using Archimedes

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1. Modeling Prioritization of Health Care for Complex Patients Using Archimedes OKPRN Convocation 2008 Dewey Scheid, MD, MPH Professor, Research Division OUHSC, Department of Family & Preventive Medicine Potential Grant Support: Agency for Healthcare Research and Quality

2. Complex Patients Require Complex Treatments Optimize Treatment There are many interventions; which should be done first? Diminishing Returns How many interventions is too many? Optimizing Prevention and Healthcare Management for the Complex Patient FOA

3. Diabetes – complex patients There are several other health conditions that often accompany a diabetes diagnosis Hypertension Hypercholesterolemia Poorly controlled blood sugars Smoking High BMI What is the best course of action for a patient with multiple health risks?

4. Diabetes – Global Burden of Disease 17th17th

5. Modeling Outcomes in Diabetes There are several computer models available that predict health outcomes Most use clinical information and clinical trial outcomes to model disease outcomes Mount Hood Challenge

6. The Fourth Mount Hood Challenge, 2004 Challenges Simulate a clinical trial of type 2 diabetes (CARDS [Collaborative Atorvastatin Diabetes Study]) Simulate a clinical trial of type 1 diabetes (DCCT [Diabetes Control and Complications Trial]) Calculate outcomes for a hypothetical, precisely specified patient prototype

7. The Fourth Mount Hood Challenge, 2004 8 modeling groups Cardiff Diabetes Model (discrete event) Sheffield Diabetes Model UKPDS Outcomes Model (discrete event) UKPDS Risk Engine (regression equation) EAGLE (Monte Carlo) CORE Diabetes Model (Monte Carlo) CDC/RTI Type 2 Diabetes Progression Model Archimedes Research triangle institute David Eddy and Leonard Schlessenger at Kaiser PermanenteResearch triangle institute David Eddy and Leonard Schlessenger at Kaiser Permanente

8. CARDS Simulation Results

9. Archimedes How it works Object oriented programming Differential equations to represent biological information Anatomy and [patho]physiology Signs and symptoms Treatment Behaviors and logistics Treatments Diabetes PhD - a simplified version, is available on a public website through the American Diabetes Association

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