Applying Dynamic Simulation Modeling Methods in Health Care Delivery Research - The SIMULATE Checklist: An ISPOR Simulation Modeling Emerging Good Practices Task Force Report

Conventional evaluation of health care interventions often neglects the wider health system impacts that 1 can be critical for achieving desired health system goals. As such, traditional health technology 2 assessment (HTA) and modeling methods are often of limited usefulness when applied to complex 3 health systems. Health care delivery systems are inherently complex consisting of multiple tiers of 4 interdependent subsystems and processes that are adaptive to changes in the local environment and 5 behave in a non-linear fashion. Often, researchers and health care decision makers either underestimate 6 or fail to consider the interactions amongst the people, processes, technology, and facility designs. 7 Health care delivery system interventions need to incorporate the dynamics and complexities of the 8 health care system context in which the intervention is delivered. 9 This report presents three dynamic simulation modeling methods to evaluate system interventions for 10 health care delivery: agent-based modeling (ABM); discrete event simulation (DES); and system 11 dynamics (SD) modeling. In contrast to conventional evaluations, a dynamic systems approach 12 incorporates the complexity of the system and anticipates the upstream and downstream consequences 13 of changes in complex health care delivery systems. It is a primer for researchers and decision makers 14 working in health care delivery science and implementation that face complex challenges to providing 15 effective or efficient care delivery that can be addressed with system interventions. 16 This report provides an overview of these modeling methods and examples of health care system 17 interventions where such methods could be useful. The report assists researchers and decision makers 18 in deciding whether these simulation methods are appropriate to address specific health systems 19 problems through an eight-point checklist (SIMULATE). The report also directs readers to other 20 resources for further education on the topic of modeling for system interventions in the emerging field of 21 health care delivery science and implementation. Upon reviewing this report, readers should be able to 22 identify if these simulation modeling methods are appropriate to answer the problem they are addressing 23 and to recognize the differences between these methods and other modeling approaches used typically 24 in HTA applications.