Examining Intervention Schemes through Simulation Modeling to Improve Access to Colorectal Cancer Care

Abstract

Colorectal cancer, commonly referred to as colon cancer, has a major impact on the US population today. Even though there are preventative measures, such as screening for developing disease, only a small percentage of the US population takes advantage of screening methods. There are a number of barriers in seeking screening. This thesis addresses the barriers that exist in accessing colon cancer care and uses simulation modeling to examine the effectiveness of various intervention schemes in improving screening rates for the North Carolina population.

Arena v. 7.0, a simulation modeling language created by Rockwell Software, was used to simulate the colon cancer system. The system was modeled using a combined discrete-continuous model since there are discrete and continuous components within the system. The dynamics among the components was investigated and modeled. The four major sectors of the model were: the health care delivery system, the role of the patient, the role of the physician, and the socioeconomic state of the system.

Intervention schemes were incorporated in the model to capture 'realistic' mechanisms. Data from many sources (primarily for North Carolina) were used to obtain numerical values for the mechanisms. There were four intervention categories that were examined in this study: improvement in resource capacity, patient adherence intervention, physician intervention, and multimedia intervention. Each simulation trial run time was 1095 days (3 years), and each trial generated the results for the performance measures, which were the basis for examining the effectiveness of the intervention schemes. The performance measures included the awareness level, the demand level, the screening level, and the screening rate.

Analysis was performed and results showed that intervention schemes that improved the awareness level were most effective in increasing the overall screening level. In addition, results showed that combining all of the intervention schemes can be very powerful and produce very high screening levels. Overall, this study provided enlightenment in how beneficial intervention schemes are and to some extent, hope that the burden of colon cancer on the US population can be alleviated.