Modeling Chronic Care Delivery as a Dynamic System-of-Systems

Healthcare delivery systems have evolved into systems-of-systems. As patients with chronic disease began moving between independent department systems, these systems were forced to “interact,” effectively gathering together to deliver chronic care as a system-of-systems (SoS). There continues to be a need to improve chronic care delivery and therefore a need to understand the structure and behavior of these healthcare systems-of-systems. A common tool applied to healthcare utilization data is graph theory and social network analysis, referred to as patient-sharing networks. However, the elements in a patient-sharing network do not comprehensively represent the elements of systems or systems-of-systems. In this paper, we extend the definitions of the nodal and edge graph elements to more comprehensively incorporate elements from systems theory. These new graphs now serve as more realistic models to understand healthcare systems-of-systems.