Figure 4
The center of the model shows a right-pointing arrow originating from a square node labeled “Susceptible population” and leading into another square node labeled “Phase 1”. In the middle of this arrow, a valve labeled “Incidence” is present. Above “Incidence”, a small circle labeled “Rate of incidence” is shown, with a short downward-pointing arrow connecting it to “Incidence”. From the square node labeled “Susceptible population”, a curved arrow arises and points toward “Incidence”. From “Phase 1”, a right-pointing arrow arises and points to a small square node labeled “Phase 2”. In the middle of this arrow, a valve labeled “Progression” is present. A curved arrow from “Phase 1” points toward “Progression”. From “Phase 2”, a right-pointing arrow originates and points to a small square node labeled “Hospitalized”. In the middle of this arrow, a valve labeled “Hospitalizations” is present. From “Phase 2”, a curved arrow arises and points toward “Hospitalizations”. From “Hospitalized”, a left-pointing arrow originates and points toward “Phase 2”. In the middle of this arrow, a valve labeled “Discharged” is present. From “Hospitalized”, a curved arrow arises and points toward “Discharged”. Below “Hospitalizations”, a circle labeled “Hosp rate” is present. From “Hosp rate”, a curved arrow arises and points toward “Hospitalizations”. Above “Discharged”, another circle labeled “Hosp days” is present. From “Hosp days”, a curved arrow arises and points toward “Discharged”. At the top left of the figure, an upward-pointing arrow originates from a small cloud-shaped icon containing a value labeled “Total costs” in the middle and leads to a square node labeled “Health expenditure”. From “Hospitalizations”, a curved arrow arises and points toward a circular node labeled “Hospital cost”. On the left side of “Hospital cost”, another small circle labeled “D R G tariff” is present, with an arrow pointing toward “Hospital cost”. From “Hospital cost”, a curved arrow arises and points toward “Total costs”. From “Phase 1”, a downward-pointing arrow originates and points to a small square node labeled “Population screened”. In the middle of this arrow, a valve labeled “Screening” is present. From “Phase 1”, a curved arrow arises and points to “Screening”. From “Susceptible population”, a curved arrow arises and points to “Screening”. From “Population screened”, a downward-pointing arrow originates and points to a small square node labeled “Patients T i C”. In the middle of this arrow, a valve labeled “T i C” is present. From the square node labeled “Patients T i C”, a right-pointing arrow originates and points to “Phase 2”, and has a valve in the arrow labeled “Progression T i C”. From “Patients T i C”, a curved arrow arises and points to “Progression T i C”. Below “Progression T i C”, a circular node labeled “Patient progression T i C” is present, with an upward-pointing arrow connecting it to “Progression T i C”. From “Population screened”, an arrow arises and extends rightward and leads to a valve labeled “Progression screened”. From that valve, the arrow extends and connects to the valve that arose from “Patients T i C”, and points to “Phase 2”. Above “Progression screened”, a small circle node labeled “Patient progression non-T i C” is present. From “Patient progression non-T i C”, two curved arrows arise and point to “Progression” and “Progression screened”. From “Population screened”, a curved arrow arises and points to “Progression screened”. On the bottom left, a double-headed arrow is shown with a small cloud-shaped icon on the left end and a square node labeled “G Ps” on the right. In the middle of this arrow, a valve labeled “Hiring G Ps” is present. From “G Ps”, a curved arrow arises and points to “Hiring G Ps”. Around “G Ps”, four circular nodes are shown above it and labeled from left to right as follows: “G P salary”, “Cost of G Ps”, “Time to recruit”, and “G Ps requirements”. From “G Ps”, a curved arrow arises and points to “Cost of G Ps”. From “G P salary”, a curved arrow arises and points to “Cost of G Ps”. From “Time to recruit” and “G Ps requirements”, curved arrows arise and point to “Hiring G Ps”. Below “Patients T i C”, a circular node labeled “Chronic patients per G P” is present. From “Chronic patients per G P”, a curved arrow arises and points to “G Ps requirements”. On the left of “Population screened”, three circular nodes are shown arranged vertically and labeled from top to bottom as follows: “Screening capacity”, “Screening per E m p”, and “Primary care capacity”. From “Primary care capacity”, a curved arrow arises and points to “T i C”. From “Screening per E m p”, a curved arrow arises and points to “Population screened”. From “Screening capacity”, a curved arrow arises and points to “Screening”. From “Screening per E m p”, a curved arrow arises and points to “Screening capacity”. From “Chronic patients per G P”, a curved arrow arises and points to “Primary care capacity”. From “G Ps”, a curved arrow arises and points to “Primary care capacity”. From “Primary care capacity” and “Screening per E m p”, curved arrows arise and point to “G Ps requirements”. On the left side of “Screening per E m p”, a double-headed arrow is shown with a small cloud-shaped icon on the left end and a square node labeled “Screening E m p” on the right. In the middle of this arrow, a valve labeled “Hiring” is present. From “Screening E m p”, a curved arrow arises and points to “Hiring”. Above “Hiring”, a circular node labeled “Employee requirements” is present. From “Employee requirements”, a curved arrow arises and points to “Hiring”. From “Susceptible population”, “Screening capacity”, and “Screening E m p”, curved arrows arise and point to “Employee requirements”. From “Time to recruit”, a curved arrow arises and points to “Hiring”. From “Cost of G Ps”, a curved arrow arises and points to “Total costs”. From “Screening E m p”, a curved arrow arises upward and points to a circular node labeled “Cost of Employees”. From “Cost of Employees”, a curved arrow arises and points to “Total costs”. On the bottom left of “Cost of Employees”, a circular node labeled “Employee salary” is present. From “Employee salary”, an arrow arises and points to “Cost of Employees”. From “Screening E m p”, a curved arrow arises upward and points to a circular node labeled “Screening capacity”. Inside all the square nodes, at the bottom left corner, a plus or minus sign is shown, except for the square node labeled “Population screened”. At the bottom left, a rectangular legend box is titled “LIST OF ABBREVIATIONS”. Inside this box, the abbreviations are listed as follows: “G P(s): general practitioner (s)”, “T i C: Taken in charge”, and “D R G: Diagnosis-related group”.The chronic care pathways redesigned based on the “endogenisation” process. Source: Authors’ own elaboration