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1、Simulacra & Simulation (& Health Care-Associated Infections),Michael Rubin, MD, PhD Section Chief, Epidemiology VA Salt Lake City Health Care System,Military Simulations,Models in which theories of warfare can be tested and refined without the need for actual hostilities Provide insights that can be
2、 applied to real-world situations a non-prescriptive attempt to inform the decision-making process,Military Simulations,Exist in many different forms, with varying degrees of realism Are they really useful?,Models in Healthcare Research,Familiar models Statistical regression models: Linear, Logistic
3、, Poisson, etc. Used for prediction, inference, hypothesis testing, and modeling of causal relationships Rely heavily on the underlying simplifying assumptions being satisfied,Models in Healthcare Research,Familiar models Equation-based models Compartmental models, Differential Equation models,Model
4、s in Healthcare Research,Less familiar models: simulations Many different types of simulations Continuous Dynamic simulations Discrete Event simulations Monte Carlo simulations Agent-based simulations,Agent-Based Models,Agent-based models Individual-based models/Individual-agent models System is mod
5、eled as collection of autonomous decision-making entities (agents) which exist/interact within an environment or framework Each agent assesses its situation and makes decisions based on a set of rules (behaviors) and characteristics (parameters) System-level observables emerge from individual action
6、s,Agent-Based Models,S,I,R,Susceptible,Infected,Recovered,Each individual agent exists in a particular “state” (“Statechart”) States correspond to the different compartments in the SIR model Transitions between states are governed by rates,Agent-Based Models,Agent-based models: Benefits Can explore
7、dynamics out of the reach of pure mathematical methods Events occur stochastically rather than deterministically Can exhibit complex behavior patterns, sometimes unanticipated Captures emergent phenomena Provides a natural description of a system What-if experimentation is accommodated,Agent-Based M
8、odels,Situations appropriate for simulation questions that are too expensive, complicated, or difficult to answer in meatspace situations where it is impossible (or extremely difficult) to know the absolute “truth“ systems with complex interactions or behaviors that are difficult to express with mat
9、hematical equations,MRSA Simulation,Detailed simulation of hospital setting Patient admissions, transfers, discharges ICU and non-ICU wards; private and double rooms Healthcare worker (doctor, nurse) contacts with patients Environmental contamination Performance of surveillance testing,Model Compone
10、nts,Patient Room Ward/ICU Nurse Physician Network structure Surveillance,Transmission pathways,Patient nurse patient Patient physician patient Patient environment nurse patient Patient environment physician patient Patient environment roommate Patient environment subsequent occupant,Agents and state
11、s,Contact Networks,Model animation,Alternative surveillance approaches Reduce (or increase) antibiotic use Improve hand hygiene Modify health care worker - patient contact networks Expedite discharge Selectively screen contacts Decolonize Carriers versus high-risk patients Health care workers,Types
12、of Interventions,MRSA Simulation,Types of questions that can be addressed: Time to observe decrease in MRSA acquisition? Do interventions exhibit threshold effects? How long will it take for a policy to exhibit an effect? Better to decolonize at admission or discharge? Time course for effects on com
13、munity prevalence? These questions cannot be fully addressed by clinical trials,Rural Health Care Access,Can simulation be used to study and optimize access to care in rural settings? How to optimize access to care across a population in a catchment area Goal is to design an interactive agent-based simulation model that can be used by researchers and planners to test varying strategies of addressing access in their system,
