A system dynamics approach to planning and evaluating interventions for chronic disease management

Studies have been reported on the applications of systems science to chronic disease management, but few, if any, have concentrated on chronic kidney disease (CKD). We examined the impact of a system dynamics approach to the evaluation of interventions in care of patients with CKD. We developed a stock flow simulation model and a multi-objective goal programming model. After calibrating the model, eight scenarios were analysed to measure intervention effects. Physician education (PE) had the most significant impact on reducing disease progression rate (DPR) from Stage 3 to Stage 4, while care coordination had a substantial impact on decreasing DPR Stage 4 to Stage 5. The addition of either CME or primary care team building to PE led to significant reductions in DPR for patients with Stage 3 CKD. The goal programming model indicated that a growing number of primary care physicians and care managers are needed to manage CKD patients overtime. This study showed that the stock flow model is a potentially powerful tool for supporting informed decision-making for planning and implementing interventions at various phases.