Systems Engineering in Health Care Coordination

Global Engineering Leadership Program

The Patient Journey

Mobility Issues

Understanding Gaps in Health Care Transitions

to Reveal Opportunities for Intervention

Robert Andr Borochok

Jasmine Bowen
Judson Kibagendi

Faculty
Dr. Harriet B. Nembhard
Hyojung Kang
Lisa Korman
David Muoz
Allison Walsh

Health care systems are complex.

There is a lack of synthesized understanding of the
complexities involved in care coordination for mobility
issues patients.
Patients often need to navigate various care settings.
Home
Palliative
Primary
Specialist Pharmacy
Specialist
Hospice
while lacking a comprehensive understanding of the
system due to limited collaboration with and amongst care
professionals.
Key to the success of a complex system is the
nonlinear interactions of its components, such that
its output is greater than the sum of its parts.
[Lipstiz, 2013]

Lack of coordination during care transitions

affects both the patients life quality and the
healthcare systems economic sustainability.
Over 10% (19 million) of US residents report having some mobility
difficulty.
Increasing Cost of Care
Diabetes $245 billion annually, $69 billion of which due to reduced productivity1
Parkinsons Disease $25 billion annually, including losses2
Rheumatoid Arthritis - $128 billion annually, $47 billion of which due to lost
earnings3

.Doesnt Mean Better Care

Diabetes 26% of patients have seen a diabetes educator in the past 12

months.4
Parkinsons Disease The average wait time for a new patient to see a
neurologist in 2012 was 35 business days.5
Rheumatoid Arthritis 22% in private healthcare had access to a 3+
multidisciplinary team, compared to 86% enrolled in national health
insurance.6

Our research journey begins

Its a two step process.
Phase 1 Establishing the Patient Journey

1. Map the
patient care
journey

2. Uncover the
gaps resulting in
inefficiency and
decreased
patient service

3. Recognize both
current and possible
interventions through
metric identification

Phase 2
Prioritizing
Interventions for
Implementation

1) We map the patient journey to understand

the relationship between care gaps and
quality of care.
The Patient Journey Parkinsons Disease
Diagnosis Phase

CS 1 Home
CS 2 Primary Care
CS 3 Hospital
CS 4 Non-Hospital Diagnostic Center
CS 5 Pharmacy
CS 6 Neurologist

1) Mapping the patient journey reveals

the various care settings involved.

2) Understanding the transitions between

care settings uncovers gaps in care.
Pre PCP

The Patient Care Journey

Rheumatoid Arthritis

Secondary Care

Ongoing
Care

Primary
Care
Multidisciplinary
Management

Ongoing
Care
Treatment
Consistent
Mobility
Issue Care
Gap Area

3) Gaps in care uncover opportunities to

implement interventions in coordination.
Primary Care Journey - Diabetes

Improved patient
involvement in
education
programs post
diagnosis

Creation of a
system that
pairs patients
with skilled
nurse specialists

Providing
higher levels of
training for
secondary care
specialists

Next Phase of Continuing Research

Prioritizing interventions for action.
Since resources are limited, we can use cost analysis and Quality Adjusted Life
Years (QALY) methodology to prioritize which interventions to implement.
We can use tools to predict the impact of implementing certain interventions.
Simulation
System dynamics
Six Sigma
Stochastic Processes
Markov Chains

Challenges
Some challenges that we have faced so far:
Identifying the care settings and phases that patients with mobility
related diseases pass through
Some care gaps are insolvable from a systems analysis perspective
(e.g. diminishing number of rheumatologists hindering specialist
availability)
Identifying and implementing interventions that could potentially
optimize the patient-care journey while controlling costs
Challenges that we will face:
Implementing Quality Adjusted Life Year (QALY) values to the
Patient journey
Proposing solutions to several gaps in health care journeys

Conclusions
Mapping the patient journey creates a visualization of
a system that makes it easier to identify gaps and
opportunities for intervention.
Improving health care coordination requires a diverse
team to provide insight on many perspectives of the
health care system.

Sources
1 http://www.diabetes.org/diabetes-basics/statistics/
2 http://www.pdf.org/en/parkinson_statistics
3 http://www.cdc.gov/arthritis/data_statistics/cost.htm
4 https://www.diabeteseducator.org/export/sites/aade/_resources/pdf/research/Diabetes_Education_Fact_Sheet_09-10.pdf
5 https://www.aan.com/PressRoom/Home/PressRelease/1178
6 http://www.ncbi.nlm.nih.gov/pubmed/10461551