title: A discrete event simulation model to evaluate the use of community services in the treatment of patients with Parkinson's disease in the United Kingdom.
abstract: The number of people affected by Parkinson's disease (PD) is increasing in the United Kingdom driven by population ageing. The treatment of the disease is complex, resource intensive and currently there is no known cure to PD. The National Health Service (NHS), the public organisation delivering healthcare in the UK, is under financial pressures. There is a need to find innovative ways to improve the operational and financial performance of treating PD patients. The use of community services is a new and promising way of providing treatment and care to PD patients at reduced cost than hospital care. The aim of this study is to evaluate the potential operational and financial benefits, which could be achieved through increased integration of community services in the delivery of treatment and care to PD patients in the UK without compromising care quality.
  
  
  
  A Discrete Event Simulation model was developed to represent the PD care structure including patients' pathways, treatment modes, and the mix of resources required to treat PD patients. The model was parametrised with data from a large NHS Trust in the UK and validated using information from the same trust. Four possible scenarios involving increased use of community services were simulated on the model.
  
  
  
  Shifting more patients with PD from hospital treatment to community services will reduce the number of visits of PD patients to hospitals by about 25% and the number of PD doctors and nurses required to treat these patients by around 32%. Hospital based treatment costs overall should decrease by 26% leading to overall savings of 10% in the total cost of treating PD patients.
  
  
  
  The simulation model was useful in predicting the effects of increased use of community services on the performance of PD care delivery. Treatment policies need to reflect upon and formalise the use of community services and integrate these better in PD care. The advantages of community services need to be effectively shared with PD patients and carers to help inform management choices and care plans.
authors.affiliation: University of Hertfordshire, AL10 9AB, Hatfield, UK.|Faculty of Medicine, Imperial College London, Hammersmith Campus, du Cane Road, London, W12 0NN, UK.
authors.forename: Reda
authors.initials: R
authors.lastname: Lebcir
authors.affiliation: University of Hertfordshire, AL10 9AB, Hatfield, UK.
authors.forename: Eren
authors.initials: E
authors.lastname: Demir
authors.affiliation: Faculty of Medicine, Imperial College London, Hammersmith Campus, du Cane Road, London, W12 0NN, UK. raheelah.ahmad@imperial.ac.uk.|Health Group, Management Department, Imperial College Business School, Exhibition Road, London, SW7 2AZ, UK. raheelah.ahmad@imperial.ac.uk.
authors.forename: Raheelah
authors.identifier: 0000-0002-4294-7142
authors.initials: R
authors.lastname: Ahmad
authors.affiliation: University of Bath, BA2 7AY, Bath, UK.
authors.forename: Christos
authors.initials: C
authors.lastname: Vasilakis
authors.affiliation: Pathways Communications, CB8 8RW, Kennett, UK.
authors.forename: David
authors.initials: D
authors.lastname: Southern
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care; D006801:Humans; D007407:Interviews as Topic; D008962:Models, Theoretical; D009740:Nursing Staff; D010300:Parkinson Disease / Q000191:economics / Q000628:therapy*; D011787:Quality of Health Care; D006113:United Kingdom
keywords: Community services; Discrete event simulation; National health service; Parkinson’s disease; United Kingdom