Jack B. Homer

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Proposals to improve the US health system are commonly supported by models that have only a few variables and overlook certain processes that may delay, dilute, or defeat intervention effects. We use an evidence-based dynamic simulation model with a broad national scope to analyze 5 policy proposals. Our results suggest that expanding insurance coverage and(More)
This paper presents results from a preliminary system dynamics simulation model of a hypothetical community in poor health and suffering from a "syndemic" of intertwined afflictions. Prevention science has moved from an emphasis on single diseases and epidemics toward a more systemic, ecological perspective, including the concept of causal feedback. From(More)
The systems modeling methodology of system dynamics is well suited to address the dynamic complexity that characterizes many public health issues. The system dynamics approach involves the development of computer simulation models that portray processes of accumulation and feedback and that may be tested systematically to find effective policies for(More)
The U.S. health care system faces serious problems of high cost, limited access, unequal treatment, and inadequate health protection. Though these problems have persisted for decades and various reforms have been attempted, the overall impact of reform efforts has been only modest. This paper examines potential types of reform and the history of reform(More)
Health planners in the Division of Diabetes Translation and others from the National Center for Chronic Disease Prevention and Health Promotion of the Centers for Disease Control and Prevention used system dynamics simulation modeling to gain a better understanding of diabetes population dynamics and to explore implications for public health strategy. A(More)
INTRODUCTION Healthy People 2010 (HP 2010) objectives call for a 38% reduction in the prevalence of diagnosed diabetes mellitus, type 1 and type 2, by the year 2010. The process for setting this objective, however, did not focus on the achievability or the compatibility of this objective with other national public health objectives. We used a dynamic(More)
This paper describes the context for and creation of a strategic planning model of a major U.S. railway. The key factors in choosing a system dynamics approach are presented, and the synergy between the new model and the existing suite of planning applications is highlighted. The overall structure of the model is reviewed, including the key reinforcing and(More)
BACKGROUND AND PURPOSE Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative's strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke(More)
Leaders across the United States face a difficult challenge choosing among possible approaches to transform health system performance in their regions. The ReThink Health Dynamics Model simulates how alternative scenarios could unfold through 2040. This article compares the likely consequences if four interventions were enacted in layered combinations in a(More)
INTRODUCTION Computer simulation offers the ability to compare diverse interventions for reducing cardiovascular disease risks in a controlled and systematic way that cannot be done in the real world. METHODS We used the Prevention Impacts Simulation Model (PRISM) to analyze the effect of 50 intervention levers, grouped into 6 (2 x 3) clusters on the(More)