Fusco D, Saitto C, Arcà M, Ancona C, Perucci C A
Department of Epidemiology, Local Health Authority RME, Roma, Italy.
Health Serv Manage Res. 2003 Nov;16(4):268-75. doi: 10.1258/095148403322488964.
The objective of this study was to assess hospital bed occupancy both by planned and unplanned cases, and to assess how supply and demand affect bed occupancy. Data was obtained from the Lazio Hospital Information System (HIS) dataset on all hospital discharges from July 1998 to June 2001. Using Diagnosis Related Groups (DRG) as the reason for hospital stay, admissions were classified into four categories: 'planned stay', 'presumed planned stay', 'presumed unplanned stay', and 'unplanned stay'. Time series analysis of daily bed occupancy by category of stay was performed. Generalized Additive Models (GAMs) were used to asses the effect of weekdays and holidays on bed occupancy. Fluctuations in daily occupancy were observed in all categories of stay-in general, bed occupancy decreased over weekends, on national holidays, and during the major holiday season of August. In comparison with unplanned stays, the largest fluctuations were observed for planned stays while presumed planned and unplanned stays showed lesser fluctuations. It is possible to distinguish planned and unplanned hospital stays by using DRG grouping. Cyclic rigidities in the supply of services rather than the availability of beds or demand for beds seem to dictate hospital use in Roma so that restrictions in services hamper any reallocation of beds for 'planned stay' when demand for 'unplanned stay' beds declines.
本研究的目的是评估计划内和计划外病例的医院床位占用情况，并评估供需如何影响床位占用。数据来自拉齐奥医院信息系统（HIS）数据集，涵盖1998年7月至2001年6月期间所有的医院出院病例。以诊断相关分组（DRG）作为住院原因，将入院病例分为四类：“计划内住院”、“推定计划内住院”、“推定计划外住院”和“计划外住院”。对按住院类别划分的每日床位占用情况进行了时间序列分析。使用广义相加模型（GAM）来评估工作日和节假日对床位占用的影响。在所有住院类别中均观察到每日占用情况的波动——总体而言，在周末、国定假日以及8月的主要节假日期间，床位占用率会下降。与计划外住院相比，计划内住院的波动最大，而推定计划内和计划外住院的波动较小。通过使用DRG分组可以区分计划内和计划外的住院情况。在罗马，似乎是服务供应的周期性刚性而非床位的可获得性或床位需求决定了医院的使用情况，因此当“计划外住院”床位需求下降时，服务限制会阻碍为“计划内住院”重新分配床位。
