Mapping the Dynamic Complexity of Chronic Disease Care in Singapore: Using Group Model Building in Knowledge Elicitation

Ansah, John P.; Matchar, David B.; Koh, Victoria; Schoenenberger, Lukas

doi:10.1002/sres.2517

Cited by 16 publications

(19 citation statements)

References 37 publications

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“…System dynamics is particularly suited to the study of complex health issues and systems and has been previously used to research matters such as health care capacity and delivery [47] and health system resilience [48]. In regards to questions specifically associated with NCDs, this study complements recent system dynamics analyses reported in the United States [49,50], Singapore [51] and Sierra Leone [52].…”

Section: Discussionmentioning

confidence: 90%

Dynamics of non-communicable disease prevention, diagnosis and control in Lebanon, a fragile setting

et al. 2021

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Background Non-communicable diseases (NCD) present an increasing global health challenge, particularly for settings affected by fragility where access to care may be disrupted, and where high-quality continuous care delivery is difficult to achieve. This study documents the complex dynamics of NCD prevention and management in the fragile setting of rural Beqaa, Lebanon. Methods Participatory system dynamics methods were used, including 30 semi-structured interviews and three Group Model Building (GMB) workshops. Participants included health care providers offering NCD care, and Lebanese host- and Syrian refugees community members affected by NCDs. Results Participants across all groups articulated a shared complex understanding of both the structural and direct determinants behind NCD onset. Lebanese and Syrian community members further identified several barriers to health seeking, including restrictions in health coverage, limited availability of services in the Beqaa and perceptions of poor-quality care. Health providers and community members described a health system overtly focused on disease control and overwhelmed by delivery of care to people living with NCD across both communities. Conclusion Participants across all groups agreed on the need for health promotion and primary prevention activities and identified priority interventions in these areas.

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Section: Discussionmentioning

confidence: 90%

Dynamics of non-communicable disease prevention, diagnosis and control in Lebanon, a fragile setting

et al. 2021

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“…Qualitative system dynamics focuses on the use of causal hypothesis generation tools, such as causal loop diagram, to articulate and visualize our understanding of the complex relationships, dynamics, and interconnectedness between interacting variables that are affecting or are affected by the issue of interest. Meanwhile, quantitative system dynamics models consist of interacting sets of differential and algebraic equations developed from the translation of the qualitative causal loop diagram to a quantitative stock and flow model from a broad range of relevant empirical data to capture dynamic interrelationship [34][35][36]. The systems modelling approach has been used to analyze various oral health problems, including modelling oral healthcare service system in the Netherlands [37], participation in oral health promotion in New York [38] and caries reductions and cost savings from early childhood caries intervention in the United States [39,40].…”

Section: Methodsmentioning

confidence: 99%

Impact of sugar-sweetened beverage tax on dental caries: a simulation analysis

et al. 2020

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Background: The tiered sugar-sweetened beverage (SSB) tax was implemented in Thailand to encourage industries to reduce sugar content in beverages, and consequently reduce sugar consumption in the population. The aim of the study is to explore the expected impact of the new SSB tax policy in Thailand, a middle-income country in Asia, and other alternative policies on oral health outcomes as measured by the prevalence and severity of dental caries among the Thai population. Methods: A qualitative system dynamics model that captures the complex interrelationships among SSB tax, sugar consumption and dental caries, was elicited through participatory stakeholder engagement. Based on the qualitative model, a quantitative system dynamics model was developed to simulate the SSB tax policy and other alternative scenarios in order to evaluate their impact on dental caries among Thai adults from 2010 to 2040. Results: Under the base-case scenario, the dental caries prevalence among the Thai population 15 years and older, is projected to increase from 61.3% in 2010 to 74.9% by 2040. Implementation of SSB tax policy is expected to decrease the prevalence of dental caries by only 1% by 2040, whereas the aggressive policy is projected to decrease prevalence of dental caries by 21% by 2040. Conclusions: In countries where a majority of the sugar consumed is from non-tax sugary food and beverages, especially Asian countries where street food culture is ubiquitous and contributes disproportionately to sugar intake, SSB tax alone is unlikely to have meaningful impact on oral health unless it is accompanied with a comprehensive public health policy that aims to reduce total sugar intake from non-SSB sources.

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“…SD is a computer-facilitated approach to policy analysis and design with a focus on modeling stocks (accumulations) and flows (rates) of systems. Typically, SD is applied to dynamic problems that are characterized by interdependence and mutual interaction of elements, information feedback, and circular causality [ 29 , 30 ]. Virtual worlds, i.e., simulation models, created with SD can act as learning laboratories with the purpose of developing and testing strategies before they are implemented in practice.…”

Section: Study Settingmentioning

confidence: 99%

Modeling Emergency Department crowding: Restoring the balance between demand for and supply of emergency medicine

et al. 2021

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Emergency Departments (EDs) worldwide are confronted with rising patient volumes causing significant strains on both Emergency Medicine and entire healthcare systems. Consequently, many EDs are in a situation where the number of patients in the ED is temporarily beyond the capacity for which the ED is designed and resourced to manage―a phenomenon called Emergency Department (ED) crowding. ED crowding can impair the quality of care delivered to patients and lead to longer patient waiting times for ED doctor’s consult (time to provider) and admission to the hospital ward. In Singapore, total ED attendance at public hospitals has grown significantly, that is, roughly 5.57% per year between 2005 and 2016 and, therefore, emergency physicians have to cope with patient volumes above the safe workload. The purpose of this study is to create a virtual ED that closely maps the processes of a hospital-based ED in Singapore using system dynamics, that is, a computer simulation method, in order to visualize, simulate, and improve patient flows within the ED. Based on the simulation model (virtual ED), we analyze four policies: (i) co-location of primary care services within the ED, (ii) increase in the capacity of doctors, (iii) a more efficient patient transfer to inpatient hospital wards, and (iv) a combination of policies (i) to (iii). Among the tested policies, the co-location of primary care services has the largest impact on patients’ average length of stay (ALOS) in the ED. This implies that decanting non-emergency lower acuity patients from the ED to an adjacent primary care clinic significantly relieves the burden on ED operations. Generally, in Singapore, there is a tendency to strengthen primary care and to educate patients to see their general practitioners first in case of non-life threatening, acute illness.

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Mapping the Dynamic Complexity of Chronic Disease Care in Singapore: Using Group Model Building in Knowledge Elicitation

Cited by 16 publications

References 37 publications

Dynamics of non-communicable disease prevention, diagnosis and control in Lebanon, a fragile setting

Dynamics of non-communicable disease prevention, diagnosis and control in Lebanon, a fragile setting

Impact of sugar-sweetened beverage tax on dental caries: a simulation analysis

Modeling Emergency Department crowding: Restoring the balance between demand for and supply of emergency medicine

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