title: Using systems science for population health management in primary care.
abstract: OBJECTIVE
  Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes.
  
  
  METHODS
  The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight.
  
  
  RESULTS
  The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period of <5 years.
  
  
  CONCLUSIONS
  Systems science methodologies can be useful to compare the health outcomes of different interventions. These tools can become an important component of population health management because they can help managers and other decision makers evaluate alternative programs in primary care settings.
authors.affiliation: The New York Academy of Medicine, New York, NY, USA Purdue University, West Lafayette, IN, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Purdue University, West Lafayette, IN, USA.
authors.forename: Nan
authors.initials: N
authors.lastname: Kong
authors.affiliation: Purdue University, West Lafayette, IN, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Lawley
authors.affiliation: The New York Academy of Medicine, New York, NY, USA jpagan@nyam.org.
authors.forename: José A
authors.initials: JA
authors.lastname: Pagán
mesh_terms: D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D003695:Delivery of Health Care / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000517:prevention & control; D004032:Diet; D019468:Disease Management; D015444:Exercise; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D050177:Overweight / Q000517:prevention & control; D011320:Primary Health Care / Q000458:organization & administration*
keywords: Medicare; agent-based modeling; population health management; primary care; systems science