Can dynamic analysis be used to optimize clinical outcome and value for money for elements of a child neurodevelopmental disorder care pathway?
The healthcare service under study, the Greater Cambridgeshire Children and Adolescents' Mental Health Services (CAMHS) Neurodevelopmental pathway, provides diagnostic assessment and therapeutic interventions for all children in Cambridgeshire who have Neurodevelopmental Disorders and comorbid mental health conditions.
A recent parliamentary enquiry into CAMHS concluded that the lack of reliable and up to date information about children's and adolescents' mental health and CAMHS meant that these services were not being designed efficiently or effectively. The report identified an urgent requirement for commissioners, providers and policy makers to have accurate information about the mental health needs of children in the region, and how service delivery can be optimized to meet those needs using limited available resources.
The provision of these services does not lend itself to the usual Randomised Controlled Trial approach to understanding how things work. In complex systems such as a healthcare service, efforts to solve a problem by an intervention create, in most cases, unanticipated side effects. Dynamic modeling can help managers understand the behavior of a complex system, predict the system’s reaction to modifications, and design sustainable policies that best serve the system. The unique strength of this research is that it employs a dynamic modeling environment to rigorously explore competing commissioning policies and provide reliable evidence for decision-making.
These techniques take multiple factors into account, including staff mix, pressures elsewhere in systems, variations in referral rates and patient need, to produce predictive models of how parameters of interest respond when the system is run under varying, well defined conditions. The goal is to provide management and staff who work within the clinical pathway with a communication tool that helps them consider, discuss, and reach mutual agreement concerning the policies that will determine the structure and functioning of the pathway.
The project will allow scarce resources to be used and adjusted to best effect, and will allow precise estimates of need within a changing environment to be made for commissioning discussions.
The team intends to prepare the research results for publication in both clinical and engineering journals. Additionally, the team intends to use the results to make applications for further funding to several grant-making bodies, including the Health Foundation, National Institute of Health Research Health Services & Delivery Research (NIHR HS&DR) funding stream, Engineering and Physical Sciences Research Council (EPSRC) and Economic and Social Research Council (ESRC).
| Prof. John Clarkson |
Department of Engineering |
| Dr. Alex Komashie |
Department of Engineering |
| Dr. Jennifer Spencer |
CAMH Consultant Psychiatrist |
