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  • 1
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 7 ( 2014-07), p. 2078-2084
    Abstract: Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative’s strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke care in the US Veteran population to inform policy and practice. Methods— A System Dynamics stroke model of the Veteran population was constructed to evaluate the relative impact of 15 intervention scenarios including both broad and targeted primary and secondary prevention and acute care/rehabilitation on cumulative (20 years) outcomes including quality-adjusted life years (QALYs) gained, strokes prevented, stroke fatalities prevented, and the number-needed-to-treat per QALY gained. Results— At the population level, a broad hypertension control effort yielded the largest increase in QALYs (35 517), followed by targeted prevention addressing hypertension and anticoagulation among Veterans with prior cardiovascular disease (27 856) and hypertension control among diabetics (23 100). Adjusting QALYs gained by the number of Veterans needed to treat, thrombolytic therapy with tissue-type plasminogen activator was most efficient, needing 3.1 Veterans to be treated per QALY gained. This was followed by rehabilitation (3.9) and targeted prevention addressing hypertension and anticoagulation among those with prior cardiovascular disease (5.1). Probabilistic sensitivity analysis showed that the ranking of interventions was robust to uncertainty in input parameter values. Conclusions— Prevention strategies tend to have larger population impacts, though interventions targeting specific high-risk groups tend to be more efficient in terms of number-needed-to-treat per QALY gained.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    RVK:
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 1467823-8
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  • 2
    Online Resource
    Online Resource
    American Public Health Association ; 2006
    In:  American Journal of Public Health Vol. 96, No. 3 ( 2006-03), p. 452-458
    In: American Journal of Public Health, American Public Health Association, Vol. 96, No. 3 ( 2006-03), p. 452-458
    Abstract: The systems modeling methodology of system dynamics is well suited to address the dynamic complexity that characterizes many public health issues. The system dynamics approach involves the development of computer simulation models that portray processes of accumulation and feedback and that may be tested systematically to find effective policies for overcoming policy resistance. System dynamics modeling of chronic disease prevention should seek to incorporate all the basic elements of a modern ecological approach, including disease outcomes, health and risk behaviors, environmental factors, and health-related resources and delivery systems. System dynamics shows promise as a means of modeling multiple interacting diseases and risks, the interaction of delivery systems and diseased populations, and matters of national and state policy.
    Type of Medium: Online Resource
    ISSN: 0090-0036 , 1541-0048
    RVK:
    Language: English
    Publisher: American Public Health Association
    Publication Date: 2006
    detail.hit.zdb_id: 2054583-6
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  • 3
    Online Resource
    Online Resource
    JSTOR ; 1971
    In:  Military Affairs Vol. 35, No. 4 ( 1971-12), p. 161-
    In: Military Affairs, JSTOR, Vol. 35, No. 4 ( 1971-12), p. 161-
    Type of Medium: Online Resource
    ISSN: 0026-3931
    Language: Unknown
    Publisher: JSTOR
    Publication Date: 1971
    SSG: 8
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  • 4
    In: Proceedings of the National Academy of Sciences, Proceedings of the National Academy of Sciences, Vol. 119, No. 23 ( 2022-06-07)
    Abstract: The opioid crisis is a major public health challenge in the United States, killing about 70,000 people in 2020 alone. Long delays and feedbacks between policy actions and their effects on drug-use behavior create dynamic complexity, complicating policy decision-making. In 2017, the National Academies of Sciences, Engineering, and Medicine called for a quantitative systems model to help understand and address this complexity and guide policy decisions. Here, we present SOURCE (Simulation of Opioid Use, Response, Consequences, and Effects), a dynamic simulation model developed in response to that charge. SOURCE tracks the US population aged ≥12 y through the stages of prescription and illicit opioid (e.g., heroin, illicit fentanyl) misuse and use disorder, addiction treatment, remission, and overdose death. Using data spanning from 1999 to 2020, we highlight how risks of drug use initiation and overdose have evolved in response to essential endogenous feedback mechanisms, including: 1) social influence on drug use initiation and escalation among people who use opioids; 2) risk perception and response based on overdose mortality, influencing potential new initiates; and 3) capacity limits on treatment engagement; as well as other drivers, such as 4) supply-side changes in prescription opioid and heroin availability; and 5) the competing influences of illicit fentanyl and overdose death prevention efforts. Our estimates yield a more nuanced understanding of the historical trajectory of the crisis, providing a basis for projecting future scenarios and informing policy planning.
    Type of Medium: Online Resource
    ISSN: 0027-8424 , 1091-6490
    RVK:
    RVK:
    Language: English
    Publisher: Proceedings of the National Academy of Sciences
    Publication Date: 2022
    detail.hit.zdb_id: 209104-5
    detail.hit.zdb_id: 1461794-8
    SSG: 11
    SSG: 12
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  • 5
    Online Resource
    Online Resource
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation Vol. 148, No. 3 ( 2023-07-18), p. 201-203
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 148, No. 3 ( 2023-07-18), p. 201-203
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1466401-X
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  • 6
    Online Resource
    Online Resource
    Institute for Operations Research and the Management Sciences (INFORMS) ; 1991
    In:  Interfaces Vol. 21, No. 3 ( 1991-06), p. 26-49
    In: Interfaces, Institute for Operations Research and the Management Sciences (INFORMS), Vol. 21, No. 3 ( 1991-06), p. 26-49
    Abstract: Intravenous drug users (IVDUs) are a high-risk group for human immunodeficiency virus (HIV) infection because of the common practice of needle sharing. A mathematical model simulates the spread of HIV infection and HIV-related death through a population of IVDUs. Special attention is given to the movement of needles between noninfectious and infectious states. The model has several input parameters that may be adjusted to represent local population characteristics and policy interventions. Use of the model for policy analysis is illustrated with a series of simulations examining the potential benefits of a needle-cleaning campaign.
    Type of Medium: Online Resource
    ISSN: 0092-2102 , 1526-551X
    Language: English
    Publisher: Institute for Operations Research and the Management Sciences (INFORMS)
    Publication Date: 1991
    detail.hit.zdb_id: 2020777-3
    detail.hit.zdb_id: 2962133-1
    SSG: 24,1
    SSG: 3,2
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  • 7
    Online Resource
    Online Resource
    Wiley ; 2012
    In:  System Dynamics Review Vol. 28, No. 3 ( 2012-07), p. 281-294
    In: System Dynamics Review, Wiley, Vol. 28, No. 3 ( 2012-07), p. 281-294
    Abstract: System dynamicists have long emphasized the use of multiple data sources and multiple methods to estimate parameters and test models. Ideally, one should estimate parameters using data " below the level of aggregation of the model" . For example, in a model of capital investment, one could estimate the length and order of the construction delay directly from data on the construction times for a large sample of relevant projects. Often, however, the needed data are not available. At the other end of the spectrum one can use " whole model estimation" in which the parameters are found by fitting the behavior of the full model to the available aggregate time series data. Whole model estimation, however, often suffers from identification problems. In this 1983 paper Jack Homer describes partial model testing, in which parameters are estimated within a subset of model structure rather than by calibration of the entire model. Homer illustrates with an example from his research on the adoption of new medical innovations, specifically, the cardiac pacemaker. He illustrates the partial model testing process with an important formulation representing how the clinical and research communities carry out and report follow‐up data on the safety and efficacy of a medical innovation as it evolves. The paper also illustrates the necessity of careful empirical work to collect new data. Debates over methods to estimate parameters are sterile without the data to implement them. In the context of medical innovation, it would have been plausible to assume that follow‐up data evaluating pacemaker efficacy would grow smoothly over time as use expanded, though perhaps with a lag. Not content with such easy assumptions, however, Homer examined every article on pacing published in every issue of the relevant cardiology journals, from the creation of the pacemaker through the (then) present. The work, done years before the advent of the Internet and online databases, was painstaking and time consuming—the journals had to be searched and articles coded by hand. The payoff was a unique dataset documenting the actual dynamics of evaluative reporting. Rather than smooth growth, the data showed a pronounced oscillation in the publication of evaluative studies, even though other data, which Homer also assembled from original sources, showed smooth growth in adoption, clinical indications and pacemaker use. Homer's model generates the same oscillation endogenously, and the partial model tests provide robust estimates of the parameters governing the institutional processes (such as research and publication delays) and behavioral decision rules (such as the decision by researchers and clinicians to initiate new follow‐up studies) that determine the existence, period, and amplitude of the cycle. The structure identified through this process was not only important to accurately model the evolution of the pacemaker, but has important policy implications still relevant today. All modelers should follow Homer's example and put in the hard work to generate, from primary sources, the data needed to estimate the important parameters and relationships in our models. John Sterman Homer J. 1983. Partial‐model testing as a validation tool for system dynamics. In Proceedings of the 1983 International System Dynamics Conference . System Dynamics Society, Chestnut Hill, MA; 919–932. Abstract This paper discusses an approach to model refinement that involves testing the behavior of individual pieces of a model in response to empirical input data for comparison with empirical output data. Partial‐model tests should be used for selecting formulations or estimating parameters only when appropriate case‐specific or logical information is not available for this purpose. The smaller the model components used for partial‐model testing, the more likely it is that the model will prove useful for anticipating events outside historical experience and the less likely it is that observed behavior will be incorrectly attributed to certain relationships or parameters. Thus, from the standpoint of structural validity, partial‐model testing is an improvement over whole‐model testing for the purpose of structural adjustment. The paper presents a detailed example of partial‐model testing in the context of a generic model of the evolving use of a new medical technology. Specifically, the technique is used for adjusting and validating a model subsystem that can explain why the reporting of clinical information on cardiac pacemakers has been marked by regular oscillations over time. Copyright © 2012 System Dynamics Society.
    Type of Medium: Online Resource
    ISSN: 0883-7066 , 1099-1727
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2012
    detail.hit.zdb_id: 2002197-5
    SSG: 24
    SSG: 3,4
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  • 8
    Online Resource
    Online Resource
    Wiley ; 2017
    In:  System Dynamics Review Vol. 33, No. 3-4 ( 2017-07), p. 336-346
    In: System Dynamics Review, Wiley, Vol. 33, No. 3-4 ( 2017-07), p. 336-346
    Type of Medium: Online Resource
    ISSN: 0883-7066 , 1099-1727
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2017
    detail.hit.zdb_id: 2002197-5
    SSG: 24
    SSG: 3,4
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  • 9
    Online Resource
    Online Resource
    Wiley ; 1993
    In:  System Dynamics Review Vol. 9, No. 1 ( 1993-24), p. 49-78
    In: System Dynamics Review, Wiley, Vol. 9, No. 1 ( 1993-24), p. 49-78
    Type of Medium: Online Resource
    ISSN: 0883-7066 , 1099-1727
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 1993
    detail.hit.zdb_id: 2002197-5
    SSG: 24
    SSG: 3,4
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  • 10
    Online Resource
    Online Resource
    Wiley ; 1985
    In:  System Dynamics Review Vol. 1, No. 1 ( 1985-22), p. 42-62
    In: System Dynamics Review, Wiley, Vol. 1, No. 1 ( 1985-22), p. 42-62
    Type of Medium: Online Resource
    ISSN: 0883-7066 , 1099-1727
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 1985
    detail.hit.zdb_id: 2002197-5
    SSG: 24
    SSG: 3,4
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