This paper describes the development of a computer simulation of the care of hip fracture, a common and serious injury with a complex journey of care. The project made use of a national, evidence-based guideline on hip fracture care, together with data from a national hip fracture audit and from service and research sources. To overcome the recognized limitations of such data in the modelling of care, clinicians from different specialties and disciplines working on hip fracture care participated by means of multi-agent-based modelling techniques.
The model followed the journey of care (admission, surgery, rehabilitation, discharge or death), and, by incorporating the clinical reasoning of experienced practitioners, was developed to reflect the realities of day-to-day clinical decision-making. It was evaluated in terms of the credibility of its outputs with clinical participants, and by formal statistical comparisons of its outputs with real outcomes from comparable groups of patients in the national audit.
The model was used to explore the impact of guideline compliance on care and resource use. Further modelling might serve to explore the implications of different service configurations for hip fracture care; to support service planning for demographic change; and to assist clinical training.
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