System Dynamics to Model the Unintended Consequences of Denying Payment for Venous Thromboembolism after Total Knee Arthroplasty
Publication Date
April 20, 2012
Journal
PLoS ONE
Authors
Mathias Worni, Ricardo Pietrobon, Guilherme Roberto Zammar, Jatin Shah, et al
Volume
7
Issue
4
Pages
e30578
DOI
https://dx.plos.org/10.1371/journal.pone.0030578
Publisher URL
http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0030578
Web of Science
000305339200003
Scopus
84859962401
Mendeley
http://www.mendeley.com/research/system-dynamics-model-unintended-consequences-denying-payment-venous-thromboembolism-after-total-kne
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Mendeley | Further Information

{"title"=>"System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty", "type"=>"journal", "authors"=>[{"first_name"=>"Mathias", "last_name"=>"Worni", "scopus_author_id"=>"8258662200"}, {"first_name"=>"Ricardo", "last_name"=>"Pietrobon", "scopus_author_id"=>"6603715961"}, {"first_name"=>"Guilherme Roberto", "last_name"=>"Zammar", "scopus_author_id"=>"35752705300"}, {"first_name"=>"Jatin", "last_name"=>"Shah", "scopus_author_id"=>"35330769100"}, {"first_name"=>"Bryan", "last_name"=>"Yoo", "scopus_author_id"=>"55193646800"}, {"first_name"=>"Mauro", "last_name"=>"Maldonato", "scopus_author_id"=>"23667876700"}, {"first_name"=>"Steven", "last_name"=>"Takemoto", "scopus_author_id"=>"56872527900"}, {"first_name"=>"Thomas P.", "last_name"=>"Vail", "scopus_author_id"=>"7004087048"}], "year"=>2012, "source"=>"PLoS ONE", "identifiers"=>{"scopus"=>"2-s2.0-84859962401", "pmid"=>"22536313", "sgr"=>"84859962401", "doi"=>"10.1371/journal.pone.0030578", "isbn"=>"1932-6203; 1932-6203", "issn"=>"19326203", "pui"=>"364661774"}, "id"=>"1d3a4e5a-0629-368a-a4f0-a924a13c268c", "abstract"=>"BACKGROUND: The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA.\\n\\nMETHODS AND FINDINGS: The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020.\\n\\nCONCLUSION: System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA.", "link"=>"http://www.mendeley.com/research/system-dynamics-model-unintended-consequences-denying-payment-venous-thromboembolism-after-total-kne", "reader_count"=>15, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>1, "Student > Doctoral Student"=>1, "Researcher"=>2, "Student > Ph. D. Student"=>2, "Student > Postgraduate"=>2, "Other"=>3, "Student > Master"=>3, "Student > Bachelor"=>1}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>1, "Student > Doctoral Student"=>1, "Researcher"=>2, "Student > Ph. D. Student"=>2, "Student > Postgraduate"=>2, "Other"=>3, "Student > Master"=>3, "Student > Bachelor"=>1}, "reader_count_by_subject_area"=>{"Engineering"=>2, "Environmental Science"=>1, "Agricultural and Biological Sciences"=>1, "Medicine and Dentistry"=>5, "Social Sciences"=>1, "Computer Science"=>3, "Economics, Econometrics and Finance"=>1, "Nursing and Health Professions"=>1}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>2}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>5}, "Social Sciences"=>{"Social Sciences"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>1}, "Computer Science"=>{"Computer Science"=>3}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>1}, "Environmental Science"=>{"Environmental Science"=>1}}, "reader_count_by_country"=>{"United Kingdom"=>1}, "group_count"=>0}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/649761"], "description"=>"<p>The fraction % of patients with osteoarthritis who might benefit from, but not receive TKA.</p>", "links"=>[], "tags"=>["patients", "osteoarthritis"], "article_id"=>320251, "categories"=>["Ecology", "Science Policy", "Medicine", "Biotechnology"], "users"=>["Mathias Worni", "Ricardo Pietrobon", "Guilherme Roberto Zammar", "Jatin Shah", "Bryan Yoo", "Mauro Maldonato", "Steven Takemoto", "Thomas P. Vail"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0030578.g003", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_fraction_of_patients_with_osteoarthritis_who_might_benefit_from_but_not_receive_TKA_/320251", "title"=>"The fraction % of patients with osteoarthritis who might benefit from, but not receive TKA.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-04-20 00:04:11"}
  • {"files"=>["https://ndownloader.figshare.com/files/649892"], "description"=>"<p>Model outputs indicating the number of harmed patients per year.</p>", "links"=>[], "tags"=>["outputs", "harmed", "patients"], "article_id"=>320378, "categories"=>["Ecology", "Science Policy", "Medicine", "Biotechnology"], "users"=>["Mathias Worni", "Ricardo Pietrobon", "Guilherme Roberto Zammar", "Jatin Shah", "Bryan Yoo", "Mauro Maldonato", "Steven Takemoto", "Thomas P. Vail"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0030578.t002", "stats"=>{"downloads"=>2, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Model_outputs_indicating_the_number_of_harmed_patients_per_year_/320378", "title"=>"Model outputs indicating the number of harmed patients per year.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-04-20 00:06:18"}
  • {"files"=>["https://ndownloader.figshare.com/files/334062"], "description"=>"<div><h3>Background</h3><p>The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA.</p> <h3>Methods and Findings</h3><p>The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020.</p> <h3>Conclusion</h3><p>System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA.</p> </div>", "links"=>[], "tags"=>["unintended", "consequences", "denying", "venous", "thromboembolism", "arthroplasty"], "article_id"=>125973, "categories"=>["Ecology", "Science Policy", "Medicine", "Biotechnology"], "users"=>["Mathias Worni", "Ricardo Pietrobon", "Guilherme Roberto Zammar", "Jatin Shah", "Bryan Yoo", "Mauro Maldonato", "Steven Takemoto", "Thomas P. Vail"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0030578", "stats"=>{"downloads"=>5, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/System_Dynamics_to_Model_the_Unintended_Consequences_of_Denying_Payment_for_Venous_Thromboembolism_after_Total_Knee_Arthroplasty/125973", "title"=>"System Dynamics to Model the Unintended Consequences of Denying Payment for Venous Thromboembolism after Total Knee Arthroplasty", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-04-20 01:39:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/649852"], "description"=>"<p>Model parameters, minimum and maximum range, and reference sources.</p>", "links"=>[], "tags"=>["public health and epidemiology", "science policy", "rheumatology", "Non-clinical medicine"], "article_id"=>320340, "categories"=>["Ecology", "Science Policy", "Medicine", "Biotechnology"], "users"=>["Mathias Worni", "Ricardo Pietrobon", "Guilherme Roberto Zammar", "Jatin Shah", "Bryan Yoo", "Mauro Maldonato", "Steven Takemoto", "Thomas P. Vail"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0030578.t001", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Model_parameters_minimum_and_maximum_range_and_reference_sources_/320340", "title"=>"Model parameters, minimum and maximum range, and reference sources.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-04-20 00:05:40"}
  • {"files"=>["https://ndownloader.figshare.com/files/649501"], "description"=>"<p>An illustration of the stocks, causal elements, relationships and impact of HACS in the system dynamics model.</p>", "links"=>[], "tags"=>["causal", "relationships", "hacs"], "article_id"=>319984, "categories"=>["Ecology", "Science Policy", "Medicine", "Biotechnology"], "users"=>["Mathias Worni", "Ricardo Pietrobon", "Guilherme Roberto Zammar", "Jatin Shah", "Bryan Yoo", "Mauro Maldonato", "Steven Takemoto", "Thomas P. Vail"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0030578.g001", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_An_illustration_of_the_stocks_causal_elements_relationships_and_impact_of_HACS_in_the_system_dynamics_model_/319984", "title"=>"An illustration of the stocks, causal elements, relationships and impact of HACS in the system dynamics model.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-04-20 02:46:24"}
  • {"files"=>["https://ndownloader.figshare.com/files/649645"], "description"=>"<p>The fraction of patients harmed by HACS over time including sensitivity analysis adjustments.</p>", "links"=>[], "tags"=>["patients", "harmed", "hacs"], "article_id"=>320132, "categories"=>["Ecology", "Science Policy", "Medicine", "Biotechnology"], "users"=>["Mathias Worni", "Ricardo Pietrobon", "Guilherme Roberto Zammar", "Jatin Shah", "Bryan Yoo", "Mauro Maldonato", "Steven Takemoto", "Thomas P. Vail"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0030578.g002", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_fraction_of_patients_harmed_by_HACS_over_time_including_sensitivity_analysis_adjustments_/320132", "title"=>"The fraction of patients harmed by HACS over time including sensitivity analysis adjustments.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-04-20 00:02:12"}

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Relative Metric

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