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NIH Funds Study of Regional Health Care Systems by ODU Researchers

A two-year grant from the National Institutes of Health (NIH) will help Old Dominion University researchers, led by Joshua Behr and Rafael Diaz, research associate professors at the Virginia Modeling, Analysis and Simulation Center (VMASC), in the study of unforeseen and unintended consequences for population health stemming from structural changes in the delivery of health care.

The project, "Policy Resistance within a Region's Healthcare System: A System Dynamics Approach," received an award of $189,766 from the NIH National Heart, Lung and Blood Institute, with continuation funding in 2013-14 for $229,500.

The research is part of a team effort that includes Bruce Britton, a professor and medical doctor within the Department of Community Health Professions at EVMS, and Harry Zhang, associate professor, and Mariana Cox-Szklo, assistant professor, from ODU's School of Community and Environmental Health. In addition, Candice Driskell, executive director of Access Partnership, the region's most prominent organization facilitating primary, specialty and oral health access for the underinsured and uninsured, is guiding the research. Access Partnership is one member of a steering committee with representation from industry and nonprofits across the region.

"This research draws upon a terrific team with a broad base of knowledge and expertise that demonstrates the collaborative energy to be had among regional stakeholders, ODU's Simulation Center, the College of Health Sciences and Eastern Virginia Medical School," Behr said. "These maturing relationships are increasingly being recognized by federal and state funders because we are able to design innovative approaches and bring unique insights into health behaviors."

The research explores the recognized problem in health care systems of the utilization of emergency departments for low-acuity conditions, resulting in congestion, sub-optimal use of resources, and erosion of patient continuity of care, all of which have documented adverse impacts on population health. For example, many patients with third-party insurance routinely use the hospital emergency room rather than their primary care provider, despite the fact it is a frequently laborious process, and may slow down access for other patients.

The researchers will leverage data from three recently funded studies conducted by the team members, one of which was a large random sample of citizens across 15 localities about patterns of behavior in the health care system. Data were gathered addressing venue utilization patterns, and the individual decision calculus involved in an individual seeking services from the emergency department.

That social-behavioral decision data will be modeled within the context of structural aspects that may either frustrate or enhance access to the health care system. The ultimate goal is a coordinated response of public health interventions or policies intended to change the behavior of target populations within the system.

Due to the scale of the health care system, in terms of dollars and numbers of patients served, an intervention that leads to a structural adjustment has the potential to alter the delivery cost and impact the quality of patient care.

The collaborative research team seeks to apply systems thinking to this health problem, modeling and creating initial simulations - utilizing system dynamics - to better optimize the use of health care resources, taking into account the interrelationships among patients, cultural norms, structural barriers, and emergency and primary care institutions.

The research effort aims to substantially increase an understanding of the dynamic demand-capacity behavior of the regional health system over time, and will highlight counterintuitive system behavior that would not have been visible through traditional analysis.

The researchers argue that the Hampton Roads community needs to address, through a coordinated effort, this policy-resistant problem. Behr said there is intense interest in this research effort from local health care providers, municipal and state officials, and charitable organizations.

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