Advanced physiotherapist-led services have been embedded in specialist orthopaedic and neurosurgical outpatient departments across Queensland, Australia, to ameliorate capacity constraints. Simulation modelling has been used to inform the optimal scale and professional mix of services required to match patient demand. The context and the value of simulation modelling in service planning remain unclear. We aimed to examine the adoption, context and costs of using simulation modelling recommendations to inform service planning. Using an implementation science approach, we undertook a prospective, qualitative evaluation to assess the use of discrete event simulation modelling recommendations for service re-design and to explore stakeholder perspectives about the role of simulation modelling in service planning. Five orthopaedic and neurosurgical services in Queensland, Australia, were selected to maximise variation in implementation effectiveness. We used the consolidated framework for implementation research (CFIR) to guide the facilitation and analysis of the stakeholder focus group discussions. We conducted a prospective costing analysis in each service to estimate the costs associated with using simulation modelling to inform service planning. Four of the five services demonstrated adoption by inclusion of modelling recommendations into proposals for service re-design. Four CFIR constructs distinguished and two CFIR constructs did not distinguish between high versus mixed implementation effectiveness. We identified additional constructs that did not map onto CFIR. The mean cost of implementation was AU$34,553 per site (standard deviation = AU$737). To our knowledge, this is the first time the context of implementing simulation modelling recommendations in a health care setting, using a validated framework, has been examined. Our findings may provide valuable insights to increase the uptake of healthcare modelling recommendations in service planning.

中文翻译：

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实施仿真建模以改进专科骨科和神经外科门诊服务的服务规划

澳大利亚昆士兰州的骨科和神经外科专科门诊部已融入先进的物理治疗师主导的服务，以改善能力限制。仿真模型已用于告知满足患者需求所需的最佳服务规模和专业服务组合。服务规划中仿真建模的背景和价值仍不清楚。我们的目的是检查使用仿真建模建议来为服务规划提供信息的采用情况、背景和成本。使用实施科学方法，我们进行了前瞻性、定性评估，以评估离散事件仿真建模建议在服务重新设计中的使用情况，并探讨利益相关者对仿真建模在服务规划中的作用的看法。选择澳大利亚昆士兰州的五个骨科和神经外科服务机构来最大限度地提高实施效果的差异。我们使用实施研究综合框架（CFIR）来指导利益相关者焦点小组讨论的促进和分析。我们对每项服务进行了前瞻性成本分析，以估计与使用模拟模型为服务规划提供信息相关的成本。五项服务中的四项通过将建模建议纳入服务重新设计提案中来展示了采用情况。四个 CFIR 构造可以区分高实施有效性和混合实施有效性，两个 CFIR 构造不能区分高实施有效性和混合实施有效性。我们确定了未映射到 CFIR 的其他结构。每个站点的平均实施成本为 34,553 澳元（标准差 = 737 澳元）。据我们所知，这是第一次使用经过验证的框架在医疗保健环境中实施模拟建模建议的背景进行检查。我们的研究结果可能会提供有价值的见解，以增加服务规划中医疗保健建模建议的采用。