Congdon P
Department of Geography, Queen Mary College, London, UK.
Health Care Manag Sci. 2001 Dec;4(4):289-304. doi: 10.1023/a:1011894312001.
This paper discusses models for the impact on patient referral flows from homes to hospitals of reconfigurations of emergency hospital services. Such system change might involve new hospital sites, or expanded bed numbers at some sites, together with possible closure of emergency units at other hospitals. In terms of a gravity model for the flows of patients, this corresponds to removing a destination or adding a new one. While retaining a gravity type approach to this problem, the relevance of supply weighting by distance within the broader accessibility concept is stressed since the independence from irrelevant alternatives property is generally inapplicable. This accessibility based approach may be implemented as a general linear model, with a Poisson outcome, and a Bayesian estimation and predictive approach is adopted. In the context of patient hospitalisations, this facilitates prediction of new patient flows following hospital reconfiguration. A UK based case study of small residential areas and hospitals in North East London and Essex is presented within the context of a review of emergency hospital siting in London.
本文讨论了急诊医院服务重新配置对患者从家庭转诊至医院的流程产生影响的模型。这种系统变化可能涉及新的医院选址，或某些地点病床数量的增加，同时其他医院的急诊科室可能会关闭。就患者流动的引力模型而言，这相当于移除一个目的地或增加一个新目的地。在保留解决此问题的引力模型方法的同时，强调了在更广泛的可达性概念中按距离进行供给加权的相关性，因为一般来说无关选项独立性属性并不适用。这种基于可达性的方法可以作为一个具有泊松结果的一般线性模型来实施，并采用贝叶斯估计和预测方法。在患者住院治疗的背景下，这有助于预测医院重新配置后的新患者流量。在对伦敦急诊医院选址进行综述的背景下，给出了一个基于英国伦敦东北部和埃塞克斯郡的小居民区及医院的案例研究。
