Geo Data Institute, University of Southampton

1. Detailed Practical Models Data Analysis and Modelling With an emphasis on Care of People with Particular Diseases and Conditions and for Planning and Managing Health Services Geo Data Institute, University of Southampton

2. Main Messages Collaborative work by Universities, Industry, and Service Organisations for Developing, testing and validating practical detailed models is mutually beneficial Geo Data Institute, University of Southampton

3. Main Messages Databases + Data analysis including classifications + Detailed models at the level of individual entities = Powerful tools for making good Planning and managing decisions Geo Data Institute, University of Southampton

4. Personal Information • Arjan Shahani • 1956 – 1963 Statistician with Philips, London • 1964 – 1967 Bristol College of Technology/Bath University • Since 1967 University of Southampton. • Developed Operational Research and collaborative work • Evolved Health work since about 1980. • Set up Institute of Modelling for Healthcare in 1987 in • Mathematics Department. • Retired from full-time formal university work in 1998. • Set up Health Data Analysis and Modelling Group in the • GeoData Institute, University of Southampton • Health work continues

5. Collaborative Work from Southampton • Collaborative work through MSc projects, PhD projects, and Commissioned research projects with many organisations • Examples • Designing a new sea port for container traffic • Forecasting milk production • Passenger flows through an airport • Interactions between research and production for new products • Flows of vegetables through an Indian Market • Planning for batch production • Care of people with particular diseases • Planning and managing capacities for health services Geo Data Institute, University of Southampton

6. Health Work At and Through Southampton • Since 1980 • Courses on Health work in Southampton MSc OR. • About 25 PhDs. About 100 MSc Projects. • About £500K obtained for funding Research Assistants for work on Health Care and Health Services. • Research work of the Operational Research Group awarded Grade 5 in a national UK evaluation exercise in 1996. Health work made a highly significant impact in this evaluation. OR Group was the only one in Maths Dept. to be awarded this top Grade.

7. Collaborative Health Work • Collaborative work with many Health professionals and • organisations in UK, Austria, Brazil, India, and Sweden. Geo Data Institute, University of Southampton

8. Nature of the Southampton Models • Based on individual patients grouped in appropriate classes. • Uncertainty and variability are taken into account PROPERLY. • Models can be easily used by health professionals • Examples • Care of people with diabetes • Critical Care capacities • Whole hospital capacities

9. A Program for Classification and Data Analysis • Rapid extraction of information from databases. • Patient flows • Patient outcomes • Use of resources • Auditing and monitoring • Links with detailed health care and health services • models • Demonstration of PORT Geo Data Institute, University of Southampton

10. Health Care Modelling • Understand and represent the PROCESSES involved in disease, care, patient flows etc. • Description of community or patient groups. • e.g. age, sex, risk groups • Disease history or patient progress • Interventions e.g. screening, vaccination, treatment, socio- • economic actions • Resources needed or planned • Costs of resources

11. Example of Health Care Modelling Data Analysis and Modelling for Early Detection and Treatment of Breast Cancer Geo Data Institute, University of Southampton

12. Breast Cancer Breast cancer is a major form of cancer in many countries. • In the UK breast cancer results in: • Annually 27,000 new registrations • and 15,000 deaths in England and Wales. • 20% of all female cancer deaths. • 5% of total female deaths. • Highmortality in women aged • 35-54 years. • In UK women between the ages • of 50 and 65 are invited for • screening at three-yearly intervals.

13. Early Detection of Breast cancer • Delay in detection can be • reduced by screening. • Apparently healthy women • can be screened through: • Self-examination. • Clinical examination. • X-rays (mammography). • Evidence from many countries • suggests that early detection reduces mortality. • Screening using mammography is available in a number of countries. Geo Data Institute, University of Southampton

14. Treatment of Breast Cancer • Many are treatments available. • Treatment depends on the severity of cancer. • Stage I: Small moveable tumour in breast only. • Stage II:Tumour not advanced but spread to lymph nodes. • Stage III:Locally advanced tumour. May be attached to chest muscles. • Stage IV:Distant metastases. • Mortality rates are the usual measures of goodness of treatment. • Mortality rates vary between hospitals and between countries. • UK mortality rates are high in comparison with Western Europe and • USA. Geo Data Institute, University of Southampton

15. Modelling Evaluation without formal cancer models Intervention Evaluation eg Randomised Controlled Trial (RCT) for annual mammography • Noisy data. • Expensive field trials • Information about annual screens • Other options need new RCT • Cancer models + data from various sources including any • necessary RCT is a powerful combination

16. Modelling of Screening for Breast Cancer • Three PhD theses: V de Senna, Y Ouinten, S Mandurah • Models given to UK Department of Health • Current UK screening policy was one of the options evaluated • by the Southampton Models Geo Data Institute, University of Southampton

17. Data and Information for Screening Model Geo Data Institute, University of Southampton

18. Screening Model Geo Data Institute, University of Southampton

19. Illustrative Results From Screening Model Stage at registration Geo Data Institute, University of Southampton

20. Illustrative Results From Screening Model Tumour doubling time (measure of cancer aggressiveness) Geo Data Institute, University of Southampton

21. Treatment Model • Very general model that can be tuned for different users. • Users define treatment for different stages of cancer, • patient progress and treatment outcomes.

22. Illustrative Results From Treatment Model Survival by stage at diagnosis.

23. Illustrative Results From Treatment Model Survival by age at diagnosis.

24. Some Southampton Health Care Models Particular Diseases Asthma, Breast Cancer, Cataracts, Cervical Cancer, Chlamydial Infection, Colorectal Cancer, Depressive Illness, Diabetes, HIV/AIDS, Trachoma Geo Data Institute, University of Southampton

25. Health Services Models Capture Patient Flows and Use of Resources Arrival of Individual patient. Patient type. Care Unit needed Admission rules for Care Units Required capacities available? No Yes Send elsewhere. Evaluate increased capacities? Admit Treat Discharge

26. Example: Planning a New Respiratory Unit No. of beds in use from a detailed model No. of beds Proposed capacity of 30 beds Days in a year

27. Example:Planning for a Group of Hospitals • Outpatients, Inpatients, Day cases at four hospitals • Detailed models at the level of individual patients grouped within about 20 specialities • Models provided detailed quantitative information about • The number of beds for each speciality • The number of operating theatres • Organisation of outpatient clinics taking the travelling times of the patients into account Geo Data Institute, University of Southampton

28. Critical Care Capacities • Demonstration of a model for planning • Critical Care Capacities • The computer solution of the model is called CCU-SIM • CCU-SIM can be tuned to represent a particular • Critical Care Unit Geo Data Institute, University of Southampton

29. Comparing Data with Model Predictions

30. Distribution of Beds Occupied • Note evidence of pressure due to heavy use of capacity Geo Data Institute, University of Southampton

31. Planning Critical Care Capacities Evaluation of Scenarios • Many scenarios involving changes in • Capacities • Case-mix and numbers of patients • Organisation of Critical Care Units • were evaluated • Some examples will illustrate the use of • Southampton models Geo Data Institute, University of Southampton

32. Increased Demand and Increased Beds

33. No Neuro Surgery Patients Geo Data Institute, University of Southampton

34. 20 Extra Planned General Surgery Patients Geo Data Institute, University of Southampton

35. Hospital Capacities Demonstration of a model for Planning Hospital capacities Geo Data Institute, University of Southampton

36. Work with Hospitals Brazil:Through Rio de Janeiro University India :G.T., Mumbai. KEM, Pune Sweden: Critical Care (Prof Walther, Dr Steins) UK:Basingstoke, Bournemouth, Chichester, Dumfries, Heatherwood, Isle of Wight, Norwich, Poole, Princess Anne, Queen Alexandra, Royal Berkshire, Salisbury, Southampton General, St Marys, Tunbridge, Winchester, + 7 others for Critical Care capacities

37. Some Southampton Health ServicesModels Hospital Capacities:Critical Care Units. A&E + MAU. Hospital Care units. Hospital (existing or new) as a whole. Outpatient Clinics:Orthopaedics, Depressive illness, ENT, Eye, Skin. Waiting Lists: Inpatients and Outpatients. Regional Capacities:Cleft lip and Palate, Coronary, Dental. Service Provision:Maternity Care. “Whole System”:Primary Care, Acute Hospital, Post-Acute Care. Forecasts of daily emergency admissions for hospitals in England. Met Office project Geo Data Institute, University of Southampton

38. Collaborative Work • MSc projects • Southampton (England) Students June to September • Linkoping (Sweden) Students September to December • PhD / MPhil projects: one to three years • Research grants • Commissioned work • Plan for work with Indian Institutes Geo Data Institute, University of Southampton

39. Collaborative Operational Research in Health A Meeting in India • Indian Health Professionals and Operational Researchers • Interested people from other countries • Meeting in January 2007 • Visiting Mumbai, Delhi, Varanasi, Pune, Coimbatore • in December 2005 for planning the meeting Geo Data Institute, University of Southampton

40. Collaborative Operational Research in Health A Meeting in India • Areas to be covered • Infectious diseases • Chronic conditions • Planning and managing health capacities • Indian System of Medicine (Ayurveda) • Combining Indian and “Western” Systems of • Medicine Geo Data Institute, University of Southampton

41. Contact Details Dr Arjan Shahani, Director, Health Data Analysis and Modelling Group, GeoData Institute, University of Southampton, Southampton SO15 7PJ akshahani@hotmail.com aks@geodata.soton.ac.uk A.K.Shahani@maths.soton.ac.uk Email to hotmail address with copies to geodata and maths addresses please Geo Data Institute, University of Southampton