Modeling to inform long-term care policy and planning for an aging society

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Demographic changes such as increasing longevity, declining family sizes, and increasing female participation in the labor market have implications for long-term care (LTC) planning for the elderly. As the population in both developed and developing world ages, the prevalence of health conditions such as chronic diseases and disabilities increases. Consequently, the proportion of elderly adults who require assistance with their daily activities rises. Further, the potential decrease in family members available as caregivers implies an increase in the demand for alternative LTC arrangements. Planning of LTC services is fraught with dynamic complexities. Various issues, such as projecting future need, cost, capacity, and quality of care and caregivers—formal and informal—can influence the effectiveness and efficiency of LTC services. The trends outlined point to the need for a comprehensive LTC planning that accounts for all these dynamics changes. This chapter aims to demonstrate the use of simulation modeling as a communication tool that allows for the LTC complexity to be reduced to its essential elements to inform policy for an aging society. The forms of simulation techniques used in the planning of LTC policy and services and real-world applications across different institutional contexts are discussed. Of particular focus is the application of the system dynamics methodology in LTC planning. Three LTC projects using system dynamics methodology are presented. Specifically, these LTC projects comprise the methodological process in the projection of the number of disabled elderly in Singapore accounting for changing educational attainment, the impact of various LTC policies on informal eldercare hours and labor force participation of informal caregivers, and the impact of LTC capacity expansion policies on acute care.






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David Bruce Matchar

Professor of Medicine

My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention.
Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analysis and cost-effectiveness analysis; (2) a balancing of methodological rigor the needs of medical professionals; and (3) dependence on interdisciplinary groups of experts.
This approach is best illustrated by the Stroke Prevention Patient Outcome Research Team (PORT), for which I served as principal investigator. Funded by the AHCPR, the PORT involved 35 investigators at 13 institutions. The Stroke PORT has been highly productive and has led to a stroke prevention project funded as a public/private partnership by the AHCPR and DuPont Pharma, the Managing Anticoagulation Services Trial (MAST). MAST is a practice improvement trial in 6 managed care organizations, focussing on optimizing anticoagulation for individuals with atrial fibrillation.
I serve as consultant in the general area of analytic strategies for clinical policy development, as well as for specific projects related to stroke (e.g., acute stroke treatment, management of atrial fibrillation, and use of carotid endarterectomy.) I have worked with AHCPR (now AHRQ), ACP, AHA, AAN, Robert Wood Johnson Foundation, NSA, WHO, and several pharmaceutical companies.
Key Words: clinical policy, disease management, stroke, decision analysis, clinical guidelines

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