Rajaguru Praveen Paul, Jusabani Mubashir Alavi, Massawe Honest, Temu Rogers, Sheth Neil Perry
1Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA USA.
Department of Orthopaedic Surgery, Kilimanjaro Christian Medical Center, Moshi, Tanzania.
Glob Health Res Policy. 2019 Oct 26;4:30. doi: 10.1186/s41256-019-0122-2. eCollection 2019.
Access to surgical care in Low- and Middle-Income Countries (LMICs) such as Tanzania is extremely limited. Northern Tanzania is served by a single tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC). The surgical volumes, workflow, and payment mechanisms in this region have not been characterized. Understanding these factors is critical in expanding access to healthcare. The authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan Africa.
The 2018 case volume and specialty distribution (general, orthopaedic, and gynecology) in the main operating theaters at KCMC was retrieved through retrospective review of operating report books. Detailed workflow (i.e. planned and cancelled cases, lengths of procedures, lengths of operating days) and financing data (patient payment methods) from the five KCMC operating theater logs were retrospectively reviewed for the available five-month period of March 2018 to July 2018. Descriptive statistics and statistical analysis were performed.
In 2018, the main operating theaters at KCMC performed 3817 total procedures, with elective procedures (2385) outnumbering emergency procedures (1432). General surgery (1927) was the most operated specialty, followed by orthopaedics (1371) and gynecology (519). In the five-month subset analysis period, just 54.6% of planned operating days were fully completed. There were 238 cancellations (20.8% of planned operations). Time constraints (31.1%, 74 cases) was the largest reason; lack of patient payment accounted for as many cancellations as unavailable equipment (6.3%, 15 cases each). Financing for elective theater cases included insurance 45.5% (418 patients), and cash 48.4% (445 patients).
While surgical volume is high, there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve capacity. Improving physical resources is not enough to improve access to care in this region, and likely in many LMIC settings. Patient financing and workflow will be critical considerations to truly improve access to surgical care.
在坦桑尼亚等低收入和中等收入国家（LMICs），获得外科治疗的机会极其有限。坦桑尼亚北部只有一家三级转诊医院，即乞力马扎罗基督教医疗中心（KCMC）。该地区的手术量、工作流程和支付机制尚未得到描述。了解这些因素对于扩大医疗服务可及性至关重要。作者试图评估撒哈拉以南非洲地区KCMC主要手术室的运营和融资情况。
通过回顾手术报告册，获取2018年KCMC主要手术室的病例数量和专科分布（普通外科、骨科和妇科）。对KCMC五个手术室日志中2018年3月至2018年7月这一可用的五个月期间的详细工作流程（即计划内和取消的病例、手术时长、手术日时长）和融资数据（患者支付方式）进行回顾性分析。进行描述性统计和统计分析。
2018年，KCMC主要手术室共进行了3817例手术，其中择期手术（2385例）多于急诊手术（1432例）。普通外科（1927例）是手术量最大的专科，其次是骨科（1371例）和妇科（519例）。在五个月的子分析期内，只有54.6%的计划手术日得以全部完成。有238例取消手术（占计划手术的20.8%）。时间限制（31.1%，74例）是最大原因；患者未付费导致的取消手术数量与设备不可用导致的取消手术数量相同（均为6.3%，各15例）。择期手术室病例的融资方式包括保险支付45.5%（418例患者）和现金支付48.4%（445例患者）。
虽然手术量很高，但系统中存在一些非物质方面的低效率问题，可以通过解决这些问题来减少取消手术的情况并提高手术能力。仅改善物质资源不足以改善该地区的医疗服务可及性，在许多低收入和中等收入国家的环境中可能也是如此。患者融资和工作流程将是真正改善外科治疗可及性的关键考虑因素。
