Engineering a Resilient Healthcare System: Using Heart Attack Outcomes and Treatment Methods in Pennsylvania; Fast and Fit: Efforts to Promote Healthier Food Options in U.S. Restaurant Chains

Pham, Emily, School of Engineering and Applied Science, University of Virginia
Barker, Shannon, EN-Biomed Engr Dept, University of Virginia
Allen, Timothy, EN-Biomed Engr Dept, University of Virginia

Due to significant gaps in current healthcare delivery models, patients have to receive non-emergent or routine care at other facilities. When fluctuating factors or unprecedented circumstances like a pandemic occur, the healthcare system is further strained and bottlenecks follow from this fixed facility model, leading to basic needs unfulfilled. The current healthcare delivery system therefore is rigid and not adaptable, unable to accommodate fluctuating variables and various scenarios. As a result, the purpose of the technical capstone project is to redesign the healthcare delivery system, specifically towards heart attacks, to improve remote/in-home health, telemedicine access, and other provisions to create a more resilient system and reduce healthcare inequalities. The STS research paper focuses on the diet-induced cause of heart attacks and how participant groups such as public health agencies, advocacies, and the FDA have sought to induce chain restaurants to offer diners healthier ingredients and dishes.

According to the CDC, the current leading cause of death in the United States and Pennsylvania is heart disease. 805,000 people per year in the U.S. experience a heart attack. However, overcrowding of hospitals exacerbated by arrival of non-emergent patients lowers treatment outcomes for patients in more critical conditions. The goal of the technical capstone project is working with Pennsylvania hospital data to simulate a patient's time spent in the hospital due to a heart attack to identify bottlenecks and variables to minimize mortality rates. With Pennsylvania having such a high heart disease rate and having one of the top healthcare systems in the U.S., it provides a good model to identify in-patient care variables that need improvement. The following are the three aims used to address the problem: applying an operations research approach to evaluate and remodel Pennsylvania’s healthcare system for heart attack patients to improve efficiency and resiliency; using operations research methods to measure the current efficiency and resiliency of the healthcare system and analyze alternative healthcare resources such as telemedicine or at-home care to suggest ways to improve this system; and determining an improvement capacity that will produce significant improvement in each of the outputs. After developing a NetLogo standard code and “improved” code in which variables are changed and additional resources are added, the capstone team applied this code to four hospitals in Pennsylvania and is still working on generating statistical results based on the data from running the simulation multiple times. From the statistical and visual data, the variable that made the largest impacts upon modification is patient arrival rate. This finding can be used as a tool in decision-making for the allocation of healthcare resources in numerous regions in the United States.

The sociotechnical problem assesses the current strategies in improving affordability, convenience, and nutritional values of meals in chain restaurants and fast food. These constraints lead the average consumer to fast meals as a result, but unfortunately many U.S. fast food restaurants exceed the recommended calorie, sodium, saturated fat, and sugar content and promote. This situation has greatly affected the American diet and promoted cardiovascular disease nationwide. Even if campaign ads on health were to increase, it would only reach the population with access. Fast food chains, public health agencies and research institutes, farm workers and advocacy groups, and government agencies like the FDA have taken different approaches to address the problem. After the assessment of various meta-analyses and literature reviews, the solutions that have been the most effective and should be implemented include decreasing portion sizes, improving ingredient quality, sales taxes on unhealthy items, removal of tax benefits for industries developing and marketing unhealthy products, continued limitation and dissentives on harmful nutritional components, and the allocation of healthy convenience stores in food deserts. These suggested methods range across multiple scales as they encompass political legislation, economic business models, social movements, and scientific research. It is a multi-prong approach and requires the collaboration of all parties and sectors. If the suggested changes and improvements to the current system are made, cardiovascular disease rates can be dramatically reduced.

Every problem has several points of development. In regards to heart attacks and cardiovascular disease in general, the sociotechnical project focuses on the prevention and mediation while the technical project addresses the treatment and outcomes. Both are necessary in efforts to eradicate cardiovascular disease. To prevent, ameliorate, and absolve the issue would decrease and hopefully eventually solve the problem. Inequities may diminish in pursuit and overall health will be enhanced for all.

BS (Bachelor of Science)
Heart Attack, Healthcare Outcomes, Agent Based Simulation, Hospital Operations, Choice Architecture

School of Engineering and Applied Science
Bachelor of Science in Biomedical Engineering
Technical Advisor: Shannon Barker, Timothy Allen, Nathan Edwards
STS Advisor: Joshua Earle, Peter Norton

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