International Journal of Medical Informatics ( IF 4.9 ) Pub Date : 2021-04-08 , DOI: 10.1016/j.ijmedinf.2021.104455 Heather Anne Smith 1 , Jean Hai Ein Yong 2 , Kami Kandola 3 , Robin Boushey 4 , Craig Kuziemsky 5
Background & aims
Colorectal cancer (CRC) mortality in the Northwest Territories (NWT), a northern region of Canada, could be reduced by implementing a CRC screening program. However, this may require additional colonoscopy resources. We used participatory simulation modeling to predict colonoscopy demand and to develop strategies for implementing a feasible and effective CRC screening program in this complex remote northern health system.
Methods
Using a participatory simulation modeling approach, we first developed a conceptual model of CRC screening with local collaborators. This approach informed our parameter adjustments of an existing microsimulation model, OncoSim-CRC, using data from a retrospective cohort review of CRC screening between 2014−2019 and secondary data. Model scenarios reflecting program implementation were run for 500 million cases. Validity was assessed, and outputs analyzed with collaborators. Alternative scenarios were developed to reduce colonoscopy demand and results were presented to end-users.
Results
We estimated that colonoscopy demand with a CRC screening program phased-in over 5 years would surpass capacity within 2 years. If demand is met, screen-detected cancers would increase by 110 %, and clinically-detected cases would reduce by 26 % over the next 30 years. We also found that prolonging the phase-in period, or revising adenoma follow-up guidelines would reduce colonoscopy demand while still improving cancer detection. Both strategies were considered feasible by collaborators. The adjusted model was valid, and the projections informed local end-users plans for CRC screening delivery.
Conclusions
Using participatory simulation modeling, we projected that a screening program would improve CRC detection but surpass current colonoscopy capacity. Phasing-in the screening program and reducing endoscopic adenoma follow-up would enhance feasibility of a CRC screening program in the NWT and help maintain its effectiveness.
中文翻译:
参与式模拟模型可为复杂的偏远北方卫生系统中的大肠癌筛查提供信息:加拿大的西北地区
背景与目标
通过实施CRC筛查计划,可以降低加拿大北部地区西北地区(NWT)的大肠癌(CRC)死亡率。但是,这可能需要其他结肠镜检查资源。我们使用参与式仿真模型来预测结肠镜检查的需求,并制定策略,以在这个复杂的偏远北部卫生系统中实施可行而有效的CRC筛查计划。
方法
使用参与式仿真建模方法,我们首先与本地合作者一起开发了CRC筛查的概念模型。该方法使用了2014-2019年CRC筛查的回顾性队列研究数据和辅助数据,为我们现有的微仿真模型OncoSim-CRC的参数调整提供了信息。反映了计划执行情况的模型场景已运行了5亿个案例。评估有效性,并与合作者一起分析产出。开发了替代方案以减少结肠镜检查需求,并将结果介绍给最终用户。
结果
我们估计,在5年内逐步实施CRC筛查程序的结肠镜检查需求将在2年内超过容量。如果满足需求,在接下来的30年中,筛查的癌症将增加110%,临床检测的病例将减少26%。我们还发现延长分期或修订腺瘤随访指南将减少结肠镜检查的需求,同时仍能改善癌症的检测。合作者认为这两种策略都是可行的。调整后的模型是有效的,这些预测通知了当地最终用户进行CRC筛查的计划。
结论
使用参与式仿真模型,我们预计筛选程序将改善CRC检测,但超过当前的结肠镜检查能力。逐步实施筛查计划并减少内窥镜腺瘤的随访将增强NWT中CRC筛查计划的可行性,并有助于维持其有效性。