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Code and material for IPACS model - Improving Patient flow between Acute, Community and Social care

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# ipacs-model
**Code and material for *IPACS Model* - Improving the Flow of Patients between Acute, Community and Social Care**

The IPACS project was funded by Health Data Research UK. It ran from May 2020-March 2023. The project was undertaken by a research team of six from Bristol, North Somerset, South Gloucestershire Integrated Care Board (BNSSG ICB) (Dr Richard Wood and Dr Paul Forte), University of Bath School of Management (Prof. Christos Vasilakis and Dr Zehra Onen Dumlu) and University of Exeter Medical School (Prof. Martin Pitt and Dr Alison Harper).

The IPACS project aimed to investigate what might constitute 'optimal capacity' along different parts of the complex care discharge pathways form acute hospital to community healthcare.

The IPACS simulation model is a high-level computer model of the discharge-to-assess (D2A) pathways.  It takes a set of input parameters (from an Excel file) and estimates potential future service outputs (occupancy, number of patients with a discharge delay, number of days waiting for discharge, total system costs) based on different configurations of parameters. The model accounts for variation in inputs and outputs, and presents results over time.

## Documentation
Please read the files in the *Documentation* folder to understand how to use, parameterise and run the model.

The model is reported using [STRESS-DES Reporting Guidelines](https://doi.org/10.1080/17477778.2018.1442155) (Monks et al. 2019)

## Citing the model
If you use the IPACS model for research, reporting, education or any other reason, please cite it using details on Zenodo
[![DOI](https://zenodo.org/badge/DOI/10.5281/zenodo.7845908.svg)](https://doi.org/10.5281/zenodo.7845908)

```
@software{alison_harper_2023_7845908,
  author       = {Alison Harper and
                  Zehra Onen Dumlu and
                  Paul Forte and
                  Christos Vasilakis and
                  Martin Pitt and
                  Richard Wood},
  title        = {{Code and material for IPACS Model - Improving the 
                   Flow of Patients between Acute, Community and
                   Social Care}},
  month        = apr,
  year         = 2023,
  publisher    = {Zenodo},
  version      = {v1.0.0},
  doi          = {10.5281/zenodo.7845908},
  url          = {https://doi.org/10.5281/zenodo.7845908}
}
```

## License  
[GPL-3 license](https://choosealicense.com/licenses/gpl-3.0/)

Permissions of this strong copyleft license are conditioned on making available complete source code of licensed works and modifications, which include larger works using a licensed work, under the same license. Copyright and license notices must be preserved. Contributors provide an express grant of patent rights. 
## Repo overview

```bash

├── IPACS_model.Rproj
├── IPACS_main script.R
│   └──set_up.R
│   └── bed_functions.R
│   └── bed_model.R
│   └── visit_functions.R
│   └── visit_model.R
│   └── ipacs_produce_report.Rmd
├── model_inputs
│   └── IPACS_params.xlsx
├── outputs
│   └── report
│   		└── .docx
│   └── report_data
│   		└── .csv
│   └── stochastic_data
│   		└── .csv
├── images
│   		└── .png
├── Documentation
│   		└── Overview
│   		└── Technical guide
│   		└── STRESS-DES reporting guidelines
├── LICENSE
├── README.md
└── .gitignore
└── .Rproj.user
└── testing
```

## Author ORCIDs

[![ORCID: Harper](https://img.shields.io/badge/ORCID-0000--0001--5274--5037-brightgreen)](https://orcid.org/0000-0001-5274-5037)
[![ORCID: OnenDumlu](https://img.shields.io/badge/ORCID-0000--0001--8878--5495-brightgreen)](https://orcid.org/0000-0001-8878-5495)
[![ORCID: Forte](https://img.shields.io/badge/ORCID-0000--0002--1060--9106-brightgreen)](https://orcid.org/0000-0002-1060-9106)
[![ORCID: Wood](https://img.shields.io/badge/ORCID-0000--0002--3476--395X-brightgreen)](https://orcid.org/0000-0002-3476-395X)
[![ORCID: Vasilaki](https://img.shields.io/badge/ORCID-0000--0002--0391--0910-brightgreen)](https://orcid.org/0000-0002-0391-0910)
[![ORCID: Pitt](https://img.shields.io/badge/ORCID-0000--0003--4026--8346-brightgreen)](https://orcid.org/0000-0003-4026-8346)

## Research Papers linked to IPACS

* [**The False Economy of Seeking to Eliminate Delayed Transfers of Care: Some Lessons from Queueing Theory**](https://link.springer.com/article/10.1007/s40258-022-00777-2)

This study aims to demonstrate how, counter to intuition, pursual of elimination of acute delayed transfers of care is likely to be uneconomical, as it would require large amounts of community capacity to accommodate even the rarest of demand peaks, leaving much capacity unused for much of the time.

*  [**Optimising the balance of acute and intermediate care capacity for the complex discharge pathway: Computer modelling study during COVID-19 recovery in England**]( https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268837)
 	
 A simulation study using the IPACS model on the effects of COVID-19 on community capacity requirements and costs to minimise acute delayed discharges.
 	
 
*  [**A Demand and Capacity Model For Home-Based Intermediate Care: Optimizing The'Step Down’Pathway**](https://ieeexplore.ieee.org/abstract/document/9715468)

An application of the discrete-time simulation model showing that total costs across the acute-community interface can be minimized by identifying optimal community capacity in terms of the maximum number of patients for which home visits can be provided by the service.

* [**Improving Hospital Discharge Flow Through Scalable Use of
Discrete Time Simulation and Scenario Analysis**](https://doi.org/10.36819/SW23.013)

This paper reports on the development and deployment of the versatile IPACS simulation tool for modelling both the home-based and bedded community step-down pathways, known as ‘Discharge to Assess’  in England’s NHS. Developed in open source ‘R’, the tool offers scalable solutions for exploring different scenarios relating to demand, capacity and patient length of stay.

A supplementary slide set is available here:
[![DOI](https://zenodo.org/badge/DOI/10.5281/zenodo.7845995.svg)](https://doi.org/10.5281/zenodo.7845995)

## Model version history
Version history is available [here](https://github.com/AliHarp/IPACS_MODEL)

This [repository](https://github.com/amyheather) contains the models, with re-coding and bug fixes, with many thanks to **Amy Heather** [![ORCID: Heather](https://img.shields.io/badge/ORCID-0000--0002--6596--3479-brightgreen)](https://orcid.org/0000-0002-6596-3479)

With additional thanks to **Dr Thomas Monks**
[![ORCID: Monks](https://img.shields.io/badge/ORCID-0000--0003--2631--4481-brightgreen)](https://orcid.org/0000-0003-2631-4481)

## Contact
For questions or feedback, please contact:

* Dr Richard Wood richard.wood16@nhs.net

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