SimCare: A Model for Studying Physician Decisionmaking Activity

Abstract : A major factor that contributes to the high rates of medical error in the treatment of patients with diabetes and other chronic diseases is the complexity of the tasks that physicians must complete. SimCare is a model of the clinical care setting for patients with type 2 diabetes. The model was designed to support investigation of physician cognition and decisionmaking activity. SimCare is dynamic and interactive and simulates diabetes management in the office-practice setting. SimCare presents a series of cases based on clinical situations representing task features that are thought to be the source of both realistic care decisions and medical errors. Once a simulated clinical case is initiated, physicians select treatment options (termed "moves") from an unguided set of choices similar to those available in routine office practice. The cumulative record of the chosen treatment moves is available for analysis and comparison with an expert's sequence of moves for each simulated patient. SimCare is potentially both an assessment and a teaching tool that enables the observation and analysis of decisionmaking in the simulated practice setting. This paper discusses the use of this tool to identify potential sources of medical errors and guide customized learning interventions designed to reduce them.

[1]  J. Ludvigsson,et al.  Särimner: a computer model of diabetes physiology for education of physicians and patients. , 1991, Diabetes research and clinical practice.

[2]  R. Carney,et al.  Depression and poor glycemic control: a meta-analytic review of the literature. , 2000, Diabetes care.

[3]  W. Katon,et al.  Depression and diabetes: impact of depressive symptoms on adherence, function, and costs. , 2000, Archives of internal medicine.

[4]  T. Deutsch,et al.  A Physiological Model Of Glucose-insulin Interaction , 1991, Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society Volume 13: 1991.

[5]  D R Wada,et al.  A PC-based graphical simulator for physiological pharmacokinetic models. , 1995, Computer methods and programs in biomedicine.

[6]  R. DeFronzo.  Pharmacologic Therapy for Type 2 Diabetes Mellitus , 1999, Annals of Internal Medicine.

[7]  E Biermann,et al.  DIABLOG: a simulation program of insulin-glucose dynamics for education of diabetics. , 1990, Computer methods and programs in biomedicine.

[8]  Roger S. Mazze,et al.  Staged diabetes management: a systematic evidence‐based approach to the prevention and treatment of diabetes and its co‐morbidities , 2001 .

[9]  Paul E. Johnson,et al.  Identification, Classification, and Frequency of Medical Errors in Outpatient Diabetes Care , 2005 .

[10]  R. Clouse,et al.  Prevalence of Depression in Adults With Diabetes: An epidemiological evaluation , 1993, Diabetes Care.

[11]  D. Kendall,et al.  Assessment of group versus individual diabetes education: a randomized study. , 2002, Diabetes care.

[12]  S. Andreassen,et al.  DIAS-NIDDM--a model-based decision support system for insulin dose adjustment in insulin-treated subjects with NIDDM. , 1998, Computer methods and programs in biomedicine.

[13]  R. K. Bernstein.  Depression in Adults With Diabetes , 1993, Diabetes Care.

[14]  Robert G. Sargent,et al.  Validation and verification of simulation models , 1999, Proceedings of the 2004 Winter Simulation Conference, 2004..

[15]  Eulalia Szmidt,et al.  Fuzzy thinking. The new science of fuzzy logic , 1996 .

[16]  David M Eddy,et al.  Archimedes: a trial-validated model of diabetes. , 2003, Diabetes care.

[17]  M Aickin,et al.  The global diabetes model: user friendly version 3.0. , 2000, Diabetes research and clinical practice.