HAZEL (HAZard-area primary carE Locator)

HAZEL is an agent-based model developed by a research team from the University Of Pittsburgh Graduate School Of Public Health and New York City Department of Health and Mental Hygiene with funding from the U.S. Assistant Secretary for Preparedness and Response. Detailed information is below the model screen.

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WHAT IS IT?

HAZEL (Hazardous Area Primary Care Locator) is a model to simulate the change in and rebuilding of the primary care system during and after Superstorm Sandy in the Rockaways, Queens, NY. It was designed and coded by teams at University of Pittsburgh (PITT) and the Bureau of Primary Care Access and Planning at New York City Department of Health and Mental Hygiene (PCAP).

PITT Team: Margaret Potter (PI), Elizabeth Ferrell-Bjerke, Leslie Fink, Hasan Guclu, Tina Batra Hershey, Supriya Kumar, and Tiffany He

PCAP Team: Angelica Bocour, Tanya Shah, Rishi Sood, and Maryellen Tria

Development: Tiffany He, Supriya Kumar and Hasan Guclu

HOW IT WORKS

HAZEL simulates the leaving/returning of individuals and closing/reopening of practices during and after Superstorm Sandy in the Rockaways to calculate the quantity and geographic distribution of individuals who need primary healthcare.

HOW TO USE IT

Buttons:

“setup” : import and show Rockaways map; select 1000 random individuals from a synthesized U.S. population data of the Rockaway area. Patients are connected to closest practices based on their capacity (panel size). In Rockaways there are about 46 practices serving the residents.
“step”: to run the simulation one step (a day) at a time

“go”: to start and continue the simulation until the user clicks again

Input boxes:

“seed”: Sets the seed of the pseudo-random number generator (used to check the consistency of the results)

“prob-”: probability of leaving/returning for individuals, and probability of practice closing/reopening

“storm-impact-duration”: total duration of the storm during which the patients evacuate and practices close and after which the patients return and practices reopen. Simulation
first runs for 5 days without a storm.

“Exceed-capacity”: If “On” the practices can accept more patients than their capacity (excess-capacity more

“excess-capacity”: The coefficient that determines the excess capacity of the practices (1 is the default capacity for each practice)

Plots and output boxes:

“Patients”:
y-axis is the number of individuals.
x-axis is the number of days from the start of the simulation.
Green line (“residents who stayed”) is the total number of people who stayed in the Rockaway area.
Purple line (“evacuated”) is the number of people who evacuated and moved temporarily from the Rockaway area.

“Practices”:
y-axis is the number of practices.
x-axis is the number of days from the start of the simulation.
Blue line (“open”) is the number of practices that are still open.
Yellow line (“closed”) is the number of practices that are closed.

“Primary Care Access Deficit”:
y-axis is the number of people.
x-axis is the number of days from the start of the simulation.
Green line (“residents who stayed”) is the total number of people who stayed in the Rockaway area. (same as the green curve in “Patients” graph).
Orange line (“with practice open”) is the number of people whose provider’s practice is still open and serving.

“Open-practice Capacity”:
y-axis is the number of people.
x-axis is the number of days from the start of the simulation.
Green line (“residents who stayed”) is the total number of people in the Rockaway area (same as the green curve in “Patients” graph).
Blue line (“practice capacity”) is the number of patients that the currently open practices can serve

“Emergency Visits (Scaled)”:
y-axis is the number of patients who visited emergency office
x-axis is the number of days from the start of the simulation.

“Patients with Closed Practices (CC)”:
Number of patients with a specific chronic condition whose provider’s practice is closed. The listed chronic conditions are hypertension (HTN), hypercholesterolemia (HCH), diabetes and asthma.

“Patients with Closed Practices (Insurance)”:
Number of patients with a specific insurance whose provider’s practice is closed. The listed insurance types are private, Medicare, Medicaid and uninsured

THINGS TO NOTICE

The simulation stops after 120 days automatically.

THINGS TO TRY

Change the value of prob-closing and prob-reopening to see the number of people who lose their primary health care provider and how primary health care deficit changes. Then change the value of prob-leaving and prob-returning to see what happens.

CREDITS AND REFERENCES

We would like to thank Rockaways Primary Care Stakeholders and NYC area partners for their help and support.

Funded through the University of Pittsburgh Center for Public Health Practice by The Assistant Secretary for Preparedness and Response Cooperative Agreement Number 1 HITEP130004-01-00. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of The Assistant Secretary for Preparedness and Response.

Data for this study was provided by the New York City Department of Health and Mental Hygiene (NYC DOHMH). The opinions, results, findings and/or interpretations of data contained herein are solely the responsibility of the authors and do not represent the opinions, interpretation, or policy of NYC DOHMH or the City of New York.