Simulation modeling and analysis of primary health center operations

Abstract

We present discrete-event simulation models of the operations of primary health centers (PHCs) in the Indian context. Our PHC simulation models incorporate four types of patients seeking medical care: outpatients, inpatients, childbirth cases, and patients seeking antenatal care. A generic modeling approach was adopted to develop simulation models of PHC operations. This involved developing an archetype PHC simulation, which was then adapted to represent two other PHC configurations, differing in numbers of resources and types of services provided, encountered during PHC visits. A model representing a benchmark configuration conforming to government-mandated operational guidelines, with demand estimated from disease burden data and service times closer to international estimates (higher than observed), was also developed. Simulation outcomes for the three observed configurations indicate negligible patient waiting times and low resource utilization values at observed patient demand estimates. However, simulation outcomes for the benchmark configuration indicated significantly higher resource utilization. Simulation experiments to evaluate the effect of potential changes in operational patterns on reducing the utilization of stressed resources for the benchmark case were performed. Our analysis also motivated the development of simple analytical approximations of the average utilization of a server in a queueing system with characteristics similar to the PHC doctor/patient system. Our study represents the first step in an ongoing effort to establish the computational infrastructure required to analyze public health operations in India and can provide researchers in other settings with hierarchical health systems, a template for the development of simulation models of their primary healthcare facilities.

Simulation modelling of hospital outpatient department: a review of the literature and bibliometric analysis

“…This cluster focuses on policy alternatives to solve the long waiting list in OPD such as patient registration [10], capacity/workload allocation [33], and pooling of patient groups like regular/urgent, first time/follow-up [18], which reduces capacity variability [10] and maximum waiting times [2,17,34] for consultation without increasing the use of healthcare resources. Radiology outpatient department has received significant research attention [18,32,33].…”

“…Appointment scheduling [4], [11], [13], [17], [34], [36], [37], [38], [39], [49], [50], [59], [64], [65], [71] [4], [11], [13], [10], [24], [34], [40], [50], [55], [29] [11], [17], [24], [40], [49], [50], [52], [55], [59], [66] Table 14. Classification of different simulation techniques used in GOPD.…”

“…General OPD Cost [28], [49], [50], [52], [55], [59], [64], [65], [66] [10], [11], [13], [17], [24], [28], [34], [37], [38], [39], [40], [49], [50], [55], [59], [64], [65], [71] [13], [37], [38], [39], [40], [59], [64], [65], [71], [119], [134], [1], [115], [136] Server overtime [11], [13], [34], [36], [38], [39], [50], [59], [64], [65], [71] [4], [28],…”

“…7 Computer modeling and simulation (M&S) approaches have also been widely used. 1 M&S allows for the experimentation of strategies to improve metrics associated with productivity and efficiency, 8 patient throughput and waiting time, 9,10 and service quality. 1,11 An increasing number of M&S studies now use a combination of simulation techniques such as discrete-event simulation, system dynamics, and agent-based simulation in the context of a single simulation study; this is referred to as hybrid simulation.…”

Simulation modeling assessment and improvement of a COVID-19 mass vaccination center operations

“…Discrete event simulation (DES), characterized by its high flexibility and speed, has been used to model, analyze, and evaluate the efficiency of hospital and public health infrastructures. [7][8][9][10][11] In this context, various researchers used the DES to build and manage mass vaccination centers. Washington 12 evaluated the design and performance of an actual mass vaccination center operated by the Henderson County Public Health Department in North Carolina, USA, during the pandemic of influenza/ pneumococcal.…”