Pediatric palliative care organization simulation model

Pediatric palliative patients are children suffering for incurable pathologies which cause them a lot of problems, to whom health services try to give a life the most close to a normal one. Only recently they have been accepted as specified patients needing qualified care. They present a wide pathologies spectrum, a large lifetime distribution and frequent changes in their conditions. The assistance aims at obtaining a clinical equilibrium permitting an acceptable life, utilizing an assistance care network including: hospital acute and intensive departments (able to supply non specific cares), hospices (able to supply specific cares), territorial structures (able to supply either specific integrated medical and social home assistance, when possible, or alternatively simple home care). An assistance plan may be set up for every patient, possibly supported by different structures in different time intervals, based on regional assistance policy, patient conditions and resources at disposition. It is necessary to consider that pediatric palliative patients compete with ordinary pediatric patients for admissions to hospital departments. From statistics supplied by hospital and territorial information systems it is possible to obtain the new patients arising rate, the length of stay distributions in all assistance structures, the length of life distributions of all patients types and the compulsory transitions among the various structures, when present. Based on such parameters, we build up a discrete stochastic simulation model describing the assistance network and reporting patients’ movements among the structures in correspondence of different assistance policies, also in case of evolving assistance organization. The scope is to evidence all lacks in satisfying users’ requests and suggest possible adjustments or new investments. The model has been applied to an actual territorial region but may be extend to other realities by suitably adapting structural and behavioural parameters.