MEASURING HEALTH SYSTEM PERFORMANCE IN DELIVERING QUALITY CARE: AN APPROACH BASED ON HOSPITAL LENGTH OF STAY Shola Adeyemi, PhD and Eren Demir, PhD StatsXperts International Consulting, 4D Alimi Road, GRA, Iloring, Nigeria. http://www.statsxperts.co.uk 1
Outline Background Methodology Results Conclusion
Background Why study LOS(patient flow)? Effective and efficient patient management Effective and efficient hospital management Health systems Benchmarking Monitoring and evaluation Capacity planning and efficient utilization of resources. PATIENT Fast access, effective Tx by trusted Professionals, involvement in decisions and respect for preferences, continuity of care... CITIZEN Affordability, universality & equity, safety & quality, health protection and disease prevention..
Background Main objectives in the healthcare industry To determine the most efficient and effective organisation for the delivery of care To maximise the quality of service at a limited cost To some degree, quality is in the eye of the beholder. This means balancing the competing views and needs of purchasers(hmos, Govts), patients, and health care professionals. Arrival Service Quality External Indicators Reduction of waiting times, patient satisfaction Internal Indicators Optimization of resource use, workload balance, quality requirements etc Service Cost Fixed and Variable Investment on resources, care delivery, transport, etc. Service Discharge Conflicting expectation in health care industry Maximum quality care vs. Minimum cost Better outcomes vs. Less resources Community LOS Healthcare Modelling!!
Methodology Modelling Long Term Care Understand flow of patients Forecast demand and cost (capacity constraints). Neonatal Capacity Planning -neonatal units were shut to new admissions. -10% of units exceeded capacity for intensive care. Meet government targets, e.g. quality of care, patient satisfaction, patient admissions (LAs are obliged to provide LTC) Stress test the system under various scenarios Information Flow Healthcare Purchaser/Provider Arrival Financial Flow Patient flow Bed Blocking Information Flow Residential care service ICU HDU SCU Hospital Support Material Flow Nursing care service Laboratories Home care service Home Healthcare Modelling!! Material Flow Exit Other Hospital Pharmacies Warehouses Information Flow Home Bed Blocking Death Other type of care
Results: LoS Modelling Modelling Long Term Care LOS and Cost Neonatal Capacity Planning -to capture the movements in the system => survival -The model gives rejection probability in terms of Arrival rate and number of cots model - This model is then used to project numbers and costs rejected 60 100 in care => cost model 50 admitted 80 40 60 30 20 10 NICU-HDU 40 20 SCBU 0 Jan Feb Mar Aprl May Jun Jul Aug Sep Oct Nov Dec 0 Jan Feb Mar Aprl May Jun Jul Aug Sep Oct Nov Dec Average LoS in short stay state is 28 days, where there is a 71.9% chance for a patient to be discharged by death. The survival probabilities can be used to project demand and cost can be used to benchmark against other local authorities. 1. NICU-HDU needs seven more cots to accept 90% NICU-HDU babies. 2. SCBU has < 5% rejection probability, because of transition care.
Conclusions Arrival Service Quality External Indicators Reduction of waiting times, patient satisfaction Internal Indicators Optimization of resource use, workload balance, quality requirements etc Service Cost Fixed and Variable Investment on resources, care delivery, transport, etc. Service Discharge Conflicting expectation in health care industry Maximum quality care vs. Minimum cost Better outcomes vs. Less resources Community New Admissions/readmissions -Health care system is a complex system with attending complex questions that require optimal solutions for accurate decision making. -Optimal solutions require optimization techniques from experienced experts (Statisticians, OR, Applied Mathematicians, Data Miners, etc,) in finding solutions to the complex problems. -We have demonstrated how LOS can be used to understand the performance and resource consumption of a health care system. 7 Healthcare Modelling! -Finding answers to complex health system problems
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