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. 2017 Sep/Oct;132(5):549-555.
doi: 10.1177/0033354917722149. Epub 2017 Aug 16.

Using Systems Science to Inform Population Health Strategies in Local Health Departments: A Case Study in San Antonio, Texas

Yan Li  1   2 , Norma A Padrón  3 , Anil T Mangla  4 , Pamela G Russo  5 , Thomas Schlenker  6 , José A Pagán  1   7   8
Affiliations

Using Systems Science to Inform Population Health Strategies in Local Health Departments: A Case Study in San Antonio, Texas

Yan Li et al. Public Health Rep. 2017 Sep/Oct.

Abstract

Objectives: Because of state and federal health care reform, local health departments play an increasingly prominent role leading and coordinating disease prevention programs in the United States. This case study shows how a local health department working in chronic disease prevention and management can use systems science and evidence-based decision making to inform program selection, implementation, and assessment; enhance engagement with local health systems and organizations; and possibly optimize health care delivery and population health.

Methods: The authors built a systems-science agent-based simulation model of diabetes progression for the San Antonio Metropolitan Health District, a local health department, to simulate health and cost outcomes for the population of San Antonio for a 20-year period (2015-2034) using 2 scenarios: 1 in which hemoglobin A1c (HbA1c) values for a population were similar to the current distribution of values in San Antonio, and the other with a hypothetical 1-percentage-point reduction in HbA1c values.

Results: They projected that a 1-percentage-point reduction in HbA1c would lead to a decrease in the 20-year prevalence of end-stage renal disease from 1.7% to 0.9%, lower extremity amputation from 4.6% to 2.9%, blindness from 15.1% to 10.7%, myocardial infarction from 23.8% to 17.9%, and stroke from 9.8% to 7.2%. They estimated annual direct medical cost savings (in 2015 US dollars) from reducing HbA1c by 1 percentage point ranging from $6842 (myocardial infarction) to $39 800 (end-stage renal disease) for each averted case of diabetes complications.

Conclusions: Local health departments could benefit from the use of systems science and evidence-based decision making to estimate public health program effectiveness and costs, calculate return on investment, and develop a business case for adopting programs.

Keywords: agent-based modeling; diabetes; local health departments; population health; systems science.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Timeline of the Center for Health Innovation at The New York Academy of Medicine Technical Assistance Project for the San Antonio Metropolitan Health District Delivery System Reform Incentive Payment Community Diabetes Project, 2015-2016. The Center for Health Innovation provided technical assistance, which included the use of systems-science simulation modeling, to help the San Antonio (Texas) Metropolitan Health District (Metro Health) assess the cost and health outcomes (cost-effectiveness) of diabetes prevention and self-management during a 20-year period (2015-2034).
Figure 2.
Figure 2.
Prevalence projections for diabetic complications occurring before and after reducing hemoglobin A1c (HbA1c) by 1% among adults with prediabetes and diabetes in San Antonio, Texas, during a 20-year period (2015-2034). In the “current” scenario (before reducing HbA1c by 1 percentage point), the simulated population had the same HbA1c distribution that was estimated from the Diabetes HbA1c Registry in San Antonio, 2011. In the “reduce HbA1c by 1 percentage point” scenario (after reducing the HbA1c by 1 percentage point), each person in the simulated population had a 1-percentage-point reduction in HbA1c at the beginning of the simulation.
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References

    1. Robert Wood Johnson Foundation Culture of Health Blog. What’s the role of local health departments in implementing the Affordable Care Act? http://www.rwjf.org/en/culture-of-health/2013/07/what_s_the_role_ofl.html. Published 2013. Accessed May 31, 2016.
    1. Hall E, Melton R, Broderick A, Wang A. Health Reform and Local Health Departments: Opportunities for the Centers for Disease Control and Prevention. Oakland, CA: Public Health Institute; 2010. http://www.phi.org/resources/?resource=health-reform-and-local-health-de.... Accessed May 31, 2016.
    1. New York State Department of Health. Template: New York State 2016 community health assessment and improvement plan and community service plan. https://www.health.ny.gov/prevention/prevention_agenda/2013-2017/docs/le.... Published 2015. Accessed May 31, 2016.
    1. Gates A, Rudowitz R, Guyer J. An Overview of Delivery System Reform Incentive Payment (DSRIP) Waivers. Menlo Park, CA: Henry J. Kaiser Family Foundation; 2014. http://kff.org/medicaid/issue-brief/an-overview-of-delivery-system-refor.... Accessed May 31, 2016.
    1. Lewis VA, McClurg AB, Smith J, Fisher ES, Bynum JPW. Attributing patients to accountable care organizations: performance year approach aligns stakeholders’ interests. Health Aff (Millwood). 2013;32(3):587–595. - PMC - PubMed

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