Simulation as a tool for evaluating intelligent self-care systems managing chronic disease patients

Using an intelligent monitoring system can be a well-thought out solution to improve HCS service quality. In this system medical staff and patients constantly interact with various electronic devices. Vital signs and health histories of patient are stored on and being transmitted between these devices, so patient will being monitored by distance and system will be updated by receiving patient’s data periodically.


Introduction
Developmental Dysplasia of the Hip (DDH) is an important cause of disability.It affects 1-3% of babies to some degree, with 1-2 in 1,000 babies having a dislocation at birth.If DDH is detected before three months it can be treated with a harness.In most cases the outcomes are good.However, if it is picked up after three months, the child may need more complex treatment, including surgery.There has been a programme in place in Ireland for DDH for years.However, there are concerns about high rates of late diagnosed hips.

Description of policy context and objective
A national multidisciplinary group representing the services involved was established to develop an evidence-based framework for the Irish DDH programme.
The aim was to improve outcomes for children by maximising the number of babies who were in treatment by 3 months by developing national recommendations and implementing an expanded ultrasound service.

Targeted population
This universal service is for all babies born in Ireland.Identifying and treating DDH involves services in the acute sector (maternity, radiology, physiotherapy, orthopaedics), primary care and general practice.This requires integrated working and information collection to ensure DDH is identified early and to quality assure the screening.

Highlights
Detailed recommendations on each stage of the pathway and the responsibilities of professionals were developed.The programme recommendation was for a physical examination of hips at birth and six weeks with early ultrasound for positive cases and supported by an ultrasound at six weeks for babies with normal examination but with either of two specified risk factors.
The group also did a review of DDH information; developed pathway maps; training curriculum; indicators; changes to IT systems; undertaking an audit; made international links; organised a training programme; and established a radiology network.
Ultrasound is not available in all units.Without it babies have to wait for an X-ray at 4 months.The Integrated Care Programme for Children secured funding to implement additional ultrasound capacity to ensure all maternity units had access to ultrasound and so the work was integrated with the group work.This work is ongoing and supported by the development of clear national recommendations for the whole pathway.

Comments on transferability
Multidisciplinary planning needs commitment from many stakeholders Progress report: We have defined a general model of patients and a model of interaction of patients with the system in which the predictions, recommendations, online help or dating are made.We are now working on the simulator and the design of the experimental phase Discussion: The proposed system not only can help us to improve the efficiency of HCS by decreasing number of personal visit by distance managing and online treating but also can prevent people from illness.in this system patient depends on their urgent situation can visit the HCS in best schedule of health care system.Conclusion: A simulation of a HCS using the intelligent model make us able to consider the mentioned system behavior in a virtual setting and can help us to best use of resources in the real world.Although simulation can investigate possibility and capability of system before implementation by analyzing the system, suggested model and behavior of patient and medical staff.
This research has been supported by MINECO SPAIN under contract TIN2014-53172-P Keywords: simulation of health care system; intelligent self care managing; agent based model; prediction and recommendation for chronics