1. Geo Data Institute, University of Southampton 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

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

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

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. Geo Data Institute, University of Southampton 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

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

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. Geo Data Institute, University of Southampton 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

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

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. High mortality 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. Geo Data Institute, University of Southampton 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.

14. Geo Data Institute, University of Southampton 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.

15. Modelling Evaluation without formal cancer models Mortality Statistics Intervention Evaluation Screening or Treatments 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. Geo Data Institute, University of Southampton 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

17. Geo Data Institute, University of Southampton Data and Information for Screening Model ∙ Cancer Register ∙ Life Tables ∙ Population ∙ Tumour Growth rate ∙ Age of Onset of Cancer ∙ Screening Processes ∙ Tumour Size ∙ Error probabilities

18. Geo Data Institute, University of Southampton Screening Model Inputs to ModelOutputs from Model Particular data sets Tumour size Expert knowledgeAggressiveness Screening optionsAge at detection eg Starting ageStage of cancer Intervals% detected by screens Type of testResources & costs Etc

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

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

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

25. Arrival of Individual patient. Patient type. Care Unit needed Admission rules for Care Units Required capacities available? Send elsewhere. Evaluate increased capacities? NoYes AdmitTreat Discharge Health Services Models Capture Patient Flows and Use of Resources

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

27. Geo Data Institute, University of Southampton 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

28. Geo Data Institute, University of Southampton 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

29. Comparing Data with Model Predictions DataModel Mean Model 95% CL for Mean Emergency Admissions822821814, 828 Elective Admissions190191187, 195 Total Admissions1012 1004, 1020 Number of Deaths184185182, 188 Bed Occupancy80.0%80.3%79.3%, 81.3% Deferral rate20%21.5%20.5%, 22.5% Transfer Rate1%1.2%1.0%, 1.4%

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

31. Geo Data Institute, University of Southampton 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

32. Increased Demand and Increased Beds (Base case has 13 beds) Base Case 14 Beds 16 Beds Emergency Admissions8228191047 Elective Admissions190 234 Total Admissions101210091281 Number of Deaths184186236 Bed Occupancy80.0%74.2%81.8% Deferral rate20%12.6%19.7% Transfer Rate1%0.6%1.2%

33. No Neuro Surgery Patients Geo Data Institute, University of Southampton Data13 Beds12 Beds Emergency Admissions770768771 Elective Admissions189194190 Total Admissions959962961 Number Died176175179 Bed Occupancy74.4%80.8% Deferral Rate15.5%25.3% Transfer Rate0.7%1.3%

34. 20 Extra Planned General Surgery Patients Geo Data Institute, University of Southampton Data13 Beds 14 Beds Emergency Admissions822 819 Elective Admissions210209212 Total Admissions10321031 Number Died 186185 Bed Occupancy81.8%76.2% Deferral Rate23.0%15.1% Transfer Rate1.3%0.6%

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

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. Geo Data Institute, University of Southampton 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 Some Southampton Health Services Models

38. Geo Data Institute, University of Southampton 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

39. Geo Data Institute, University of Southampton 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

40. Geo Data Institute, University of Southampton 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

41. Geo Data Institute, University of Southampton 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