We present discrete-event simulation models of the operations of primary health centres (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 modelling 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 utilisation values at observed patient demand estimates. However, simulation outcomes for the benchmark configuration indicated significantly higher resource utilisation. Simulation experiments to evaluate the effect of potential changes in operational patterns on reducing the utilisation of stressed resources for the benchmark case were performed. Our analysis also motivated the development of simple analytical approximations of the average utilisation 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 analyse 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.
翻译:印度的初级保健模拟模型包括四类寻求医疗护理的病人:门诊病人、住院病人、分娩病例和产前护理病人。我们采用了一种通用模拟方法来开发初级保健业务的模拟模型。这包括开发一个古老的初级保健模拟模型,然后加以调整,以代表另外两种初级保健结构,这种结构在资源和所提供服务类型上各不相同,在初级保健访问中遇到。一个模型代表一种基准配置,符合政府授权的业务准则,其需求来自疾病负担数据和服务时间估计更接近国际估计(比观察的要高)。还开发了三种观察到的配置的模拟结果,表明病人等待时间微不足道,在观察到的病人需求估计中资源利用率低。然而,基准配置的模拟结果表明资源利用率要高得多。模拟实验,以评价业务模式可能发生的变化对减少使用受压力的资源为基准案件带来的影响。我们的分析还推动了从疾病负担数据和服务时间到国际估计时间(比观察的要高)的需求。三种观察到的组合的模拟结果显示,病人等待时间微不足道,在观察到的病人需求估计时资源利用率低。但是,基准配置的模拟结果显示资源利用率要高得多。模拟结果显示,评估业务模式在减少压力的资源使用基准案例中的影响。 我们的系统在进行中,其平均的排序中,可以进行中进行中进行中进行。