A network flow approach to optimizing hospital bed capacity decisions

The delivery of cost-effective and quality hospital-based health care remains an important and ongoing challenge for the American health care industry. Despite numerous advances in medical procedures and technologies, a growing array of outpatient health care options, limits on inpatient reimbursements, and almost two decades of hospital contraction and consolidation, annual inpatient admissions in the United States are currently at levels not seen since the early 1980s. This combination of increased demand and diminished resources makes planning for hospital bed capacity a difficult problem for health care decision makers. We examine this problem by developing a network flow model that incorporates facility performance and budget constraints to determine optimal hospital bed capacity over a finite planning horizon. Under modest assumptions, we demonstrate that for realistic sized capacity planning problems, our network formulation is not computationally intensive, and allows us to obtain optimal bed capacity plans quickly.     

绵阳地区儿科资源配置现状分析

目的分析绵阳地区医疗机构儿科卫生资源配置现状,提出相应的政策建议为儿科学科建设提供参考。方法对绵阳地区19家医疗机构采取普查法。收集卫生资源数据,利用Microsoft Excel 2010建立数据库。结果绵阳地区儿科医护比为1:1.62,医护人员学历、职称均较低,队伍年轻化,物力资源集中在三级医院,其配置效率普遍较高。在医院总收入中,儿科占比平均为6.15%,儿科人均住院费用平均为2 429.5元,人均门诊费用98.53元,药占比平均为30.29%。在年门诊量、年急诊量、年出院人次方面,儿科的占比分别为11.36%、40.64%、12.66%。儿科床位使用率三级医院（105.2%）高于三级以下医院（74.38%）,儿科亚专业开设欠缺。结论儿科医疗服务需求大,人力资源严重不足;儿科医护人力资源素质水平有待提高;儿科卫生资源配置欠合理,财力资源较理想。应加强分级诊疗力度,加大三级以下医院儿科急诊资源投入力度,提高其床位使用率,同时加强各层医疗机构儿科医护人员培训力度。     

安徽省医疗机构精神卫生服务资源和利用现状调查

目的 了解2018年安徽省医疗机构精神卫生服务资源和利用情况，为今后有针对性地开展工作提供依据。方法 采用自行设计的调查表收集全省2018年精神卫生医疗机构的相关数据。结果 （1）全省开设心理门诊或（和）精神科的医疗机构79家，包括56家公立医疗机构和23家民营医疗机构。（2）全省精神科执业（助理）医师共有1 336名，精神科执业（助理）医师密度达到2.11名/10万人，开设床位15 153张，床位密度2.40张/万人。（3）2018年全省精神科门诊及心理门诊量1 477 879人次，急诊量22 094人次，入院患者数量101 638人次，出院患者数量108 282人次，出院患者平均住院日39.78（24.00，64.60） d，床位使用率102.75%。结论 2018年安徽省精神卫生资源与过去相比虽然取得了长足的发展，但是精神卫生服务能力仍达不到社会对精神卫生服务的需求。     

成都市优质医疗资源可及性评价与空间优化

目的 对成都市优质医疗资源设施的空间可及性和各小区拥有的优质医疗资源水平进行分析,并对成都市优质医疗资源进行初步的空间优化。方法 本文优质医疗资源采用三级综合和专科医院衡量。小区数量和小区人口信息通过爬取二手房网站(贝壳网)获取,共得到12 521个小区信息,小区人口数按照爬取的小区户数乘上第七次人口普查成都市每户的平均人口数2.49人获得; 在此基础上,本文首先运用最优路径分析方法和两步移动搜寻方法对成都市三级医院空间可及性进行分析,随后从供需双方的角度对成都市三级医院医疗服务水平进行评价。结果 成都市优质医疗资源总体的可及性较好,仅有3.9%的小区达到优质医疗机构的距离大于15 km,2.1%的距离大于30 km。成都市中心地区小区单元享受优质医疗机构数量为10～55家,而南部和西部边缘地区小区单元享受的优质医疗机构数量仅有0～1家。成都北部、东部和西部部分地区小区每千人口享有优质医疗机构病床数大于25,而西北部和南部部分地区享受病床数不足1。通过对优质医疗资源位置分配分析,需增加5家三级医院即可满足目前小区单位人口的优质医疗服务需求。结论 成都市优质医疗资源空间布局存一定的问题,可通过新增优质医疗资源及加强道路建设提高空间可及性。     

Between two beds: inappropriately delayed discharges from hospitals

Acknowledging the necessity of a division of labour between hospitals and social care services regarding treatment and care of patients with chronic and complex conditions, is to acknowledge the potential conflict of interests between health care providers. A potentially important conflict is that hospitals prefer comparatively short length of stay (LOS) at hospital, while social care services prefer longer LOS all else equal. Furthermore, inappropriately delayed discharges from hospital, i.e. bed blocking, is costly for society. Our aim is to discuss which factors that may influence bed blocking and to quantify bed blocking costs using individual Norwegian patient data, merged with social care and hospital data. The data allow us to divide hospital LOS into length of appropriate stay (LAS) and length of delay (LOD), the bed blocking period. We find that additional resources allocated to social care services contribute to shorten LOD indicating that social care services may exploit hospital resources as a buffer for insufficient capacity. LAS increases as medical complexity increases indicating hospitals incentives to reduce LOS are softened by considerations related to patients’ medical needs. Bed blocking costs constitute a relatively large share of the total costs of inpatient care.     

Factors affecting the increase in hospitalized medical care expenditure in Japan: analysis of national data in all 47 prefectures]

To clarify factors affecting the increase in annual expenditure for hospitalized medical care in Japan, the effects of the following four variables in all 47 prefectures were analyzed: (1) the hospitalized medical care expenditure per day per inpatient, (2) the number of admissions per population base, (3) average length of stay of patients in hospital per year and (4) the number of hospital beds per population base. The annual expenditure for hospitalized medical care per population base was correlated most significantly with the number of hospital beds per population base. The annual expenditure was also significantly correlated positively with the number of admissions per population base and average length of stay of patients in hospital per year, and inversely with the hospitalized medical care expenditure per day per inpatient. Hospitalized medical care expenditure per day per inpatient was inversely correlated with average length of stay of patients in hospital and the number of hospital bed per population base. Results from stepwise multiple regression analysis indicated that the number of hospital bed per population base and the hospitalized medical care expenditure per day per inpatient are the only two variables which have significant effects on the annual expenditure for hospitalized medical care per population base. The annual rate of increase for annual expenditure for hospitalized medical care per population base from 1980 to 1986 was 6.1%. Similarly, the rate of increase in the hospitalized medical care expenditure per day per inpatient was 3.5%; that of the number of admissions per population base was 3.1%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Beyond demographic change in human resources planning: an extended framework and application to nursing

OBJECTIVES: To introduce health care production functions into human resources planning and to apply the approach to analysing the need for registered nurses in Ontario during a period of major reduction in inpatient capacity. METHODS: Measurement of changes in services delivered by acute care hospitals in Ontario between 1994/95 and 1998/99, and comparison with changes in the mix of human resources, non-human resources and patient needs. RESULTS: Inpatient episodes per nurse fell by almost 2%. At the same time the number of beds was cut by over 20%. As a result, the number of patients per bed increased by 12%. Allowing for severity, there was a 20% reduction in beds per episode and a 3.7% reduction in nurses per episode. CONCLUSIONS: The demands on nurses in acute care hospitals have increased as an increasing number of severity-adjusted episodes are served using fewer beds by a reduced number of nurses. Human resources planning traditionally only considers the effects of demographic change on the need for and supply of health care. Failure to recognize the variable and endogenous nature of other health care inputs leads to false impressions about the adequacy of existing supplies of human resources. Consideration of human resources in the context of the production function for health services provides a meaningful way of improving the effectiveness and efficiency of human resources planning.     

Do community hospitals reduce the use of district general hospital inpatient beds?

Community hospitals have been supported by the general public and by professionals as one means of increasing choice between local, low technology, care and high technology care at the district general hospital. However, there is no information on the impact of community hospitals on district general hospital use subsequent to NHS and community care reforms. Examination of routinely gathered activity data in the Bath Health District revealed that availability of community hospital beds was associated with reduced use of central inpatient services in the city of Bath. The reduction was most apparent for medical and geriatric beds. Decrease in the use of surgical beds was small. However, total inpatient bed use (including central and community hospital beds) was higher in the population with access to community hospital beds. We conclude that community hospitals offer one option for accessible health care and, as such merit systematic evaluation of costs and benefits. This study presents some evidence that savings could be achieved through improved efficiency.     

应对传染病流行事件的发热门诊和定点救治医院空间可达性分析——以湖南省为例

目的:描述分析发热门诊和定点救治医院的空间分布与可达性,为应对重大传染病流行事件的医疗资源供给配置提供参考依据。方法:以湖南省344家发热门诊和224家定点救治医院(含后备医院)为研究对象,采用最近设施点分析和两步移动搜索法分别分析发热门诊和定点救治医院的可达性。结果:湖南省发热门诊每10万人0.51个,45.25%的居民和16.31%的地域能在15分钟内行车到达发热门诊;发热门诊呈现以县中心可达性高且向边缘递减的空间格局。湖南省定点救治医院的床位总数为14.35万张,每万人床位数为21.19张。结论与建议:湖南省发热门诊在市县之间空间分布较为均衡,人口密度较高的城市配置较多,但行车60分钟才能基本覆盖全域和绝大部分居民,一定程度上影响"哨点"作用的发挥。建议结合湖南省基层医疗机构的资源进一步优化农村地区发热门诊以及城市定点救治医院的布局配置。     

Hospital activity related to a stage II experiment regarding intensification of the use of hospital beds

It is pointed out that there are some reserves for significant intensification of the use of the existing resources in inpatient establishments. Organizational measures, material stimulation of the hospital staff and financing of hospitals per patient enable one to increase the amount of medical care provided by each hospital. The experimental results indicate the potentiality of satisfying the population's claims for inpatient care without increase of bed fund capacity.     

天津市居民住院医疗机构选择及影响因素

目的了解天津市近10年来不同医疗机构入院人数和病床使用率的变化,分析影响居民选择住院机构的因素,为制定区域卫生规划,优化区域卫生资源配置提供参考.方法利用天津市1998年至2008年卫生统计年鉴和1993年至2008年四次卫生服务调查数据,采用SPSS16.0的描述性统计和有序多分类logistic回归对数据进行分析.结果 1998年至2008年间,与二级及以上医院和农村卫生院相比,社区卫生服务中心(站)的入院人数和病床使用率增幅最小,且社区卫生服务中心和农村卫生院的病床使用率一直低于二级及以上医院;居民选择住院医疗机构的影响因素有住院费用、性别、职业类型、征求治疗方案意见、地区分类.结论天津市需要加强社区卫生服务中心(站)建设,提高基层医疗卫生服务机构能力建设.     

How many beds? Capacity implications of hospital care demand projections in the Irish hospital system, 2015‐2030

Existing Irish hospital bed capacity is low by international standards while Ireland also reports the highest inpatient bed occupancy rate across OECD countries. Moreover, strong projected population growth and ageing is expected to increase demand for hospital care substantially by 2030. Reform proposals have suggested that increased investment and access to nonacute care may mitigate some increased demand for hospital care over the next number of years, and it is in this context that the Irish government has committed to increase the supply of public hospital beds by 2600 by 2027. Incorporating assumptions on the rebalancing of care to nonhospital settings, this paper analyses the capacity implications of projected demand for hospital care in Ireland to 2030. This analysis employs the HIPPOCRATES macrosimulation projection model of health care demand and expenditure developed in the ESRI to project public and private hospital bed capacity requirements in Ireland to 2030. We examine 6 alternative projection scenarios that vary assumptions related to population growth and ageing, healthy ageing, unmet demand, hospital occupancy, hospital length of stay, and avoidable hospitalisations. We project an increased need for between 4000 and 6300 beds across public and private hospitals (an increase of between 26.1% and 41.1%), of which 3200 to 5600 will be required in public hospitals. These findings suggest that government plans to increase public hospital capacity over the 10 years to 2027 by 2600 may not be sufficient to meet demand requirements to 2030, even when models of care changes are accounted for.     

铁路医疗保障制度改革对铁路医院病床工作效率的影响

目的探讨铁路医疗保障制度改革对铁路医院经营以及医疗工作的影响.方法运用质量控制图,对铁路职工医疗保障制度改革前后,某铁路中心医院病床工作效率指标变动情况进行分析.结果2004年2月铁路医疗保障制度启动,病人选择性就医的自由度加大,病人的卫生服务有效需求发生了转移,一部分铁路医保病人流向了有较强竞争力的其他医院,使得医院病床工作效率值骤然下降,低于病床工作效率控制下限;此后,铁路系统内病人外流造成的床位"空缺"逐渐被医院服务半径内的其他病人占用,医院病床工作效率逐渐缓慢回升,至2005年5月已接近医改前病床工作效率值平均水平.结论医保付费模式对医疗机构的内部管理提出了更高要求,铁路医院要在医疗制度改革的激烈医疗市场竞争中立于不败之地,应规范医疗行为,做到合理检查,合理治疗、合理用药.同时,定期考核医保规章制度执行情况,实施医疗费用公示,开展循证医学实践,主动适应并积极应对医疗市场的竞争,才能在改革的大潮中立于不败之地.     

2007年广州市区医疗废物及污水产生与处理分析

目的 了解2007年广州市区医疗废物、污水产生及治理现状.方法 对市区≥20床医疗机构(共227所)医疗废物及污水产生及处理等情况进行普查.结果 医疗废物产生总量为7290.5吨;在各类机构中综合医院日床均医疗废物产生量最多(0.45 kg);医疗废物无害化处置率为99.5%,99.2%医疗废物采用送医疗废物处置厂集中处置的方式;227所医疗机构年污水产生量为1501.7万吨,污水实际处理总率为82.7%;其中综合医院污水处理率最高(84.6%);污水处理工艺多采用一级处理及加氯等处理,但仍有11所医疗机构其污水直接排入水环境.结论 相关部门加强监管,促进医疗机构完善管理并改良技术.     

The use of bed distribution and service population indexes for hospital bed allocation.

To provide an empirical base for bed reallocation within a hospital planning jurisdiction in Canada, this article proposes a population-based method to measure the distribution of acute care beds for each district and the service load for each hospital. The measure for the bed distribution (BDI) is the number of beds per 1,000 age-sex-adjusted number of residents in a district, while the service load of a hospital is measured by the number of persons being served per bed (SPI). The number of beds allocated to each district, or the number of persons served by each hospital, was estimated by applying the hospital service population model, which employs both relevance- and commitment-index methods. The method thus proposed was applied to Alberta data. It appears that both BDI and SPI measures are stable across the variation of methods or data sources, yet sensitive enough to detect changes over the years. Using these indexes, potentially over- or underbedded districts and over- or underloaded hospitals can be identified for further investigation so that possible reallocation of acute care beds among the hospitals may take place.     

我国医疗机构儿科床位配置现状研究

目的：分析我国医疗机构儿科床位配置现状及公平性,为合理配置儿科床位提供建议。方法：在全国随机抽取44个地市,对提供儿科住院服务的医疗机构儿科床位设置、服务提供和利用情况进行问卷调查。结果：我国平均每千人口拥有儿科床位0.20张。县区级医疗机构床位数量最多,占44.9%,乡级机构次之,占29.4%,市级及以上机构最低,占25.7%。2008—2010年儿科床位数和服务数量均呈现增长趋势,其中中部地区床位数增长最快。儿科床位利用率高于全国医疗机构整体床位利用率。全国儿科床位配置泰尔指数为0.0775,各地区之间为0.0164。不同地区的儿科床位供需比值在0.54～1.04之间。结论：我国儿科床位总体数量不足,儿科床位比例基本合理,东中西部地区内部儿科床位分布不公平性大于地区间不公平性。建议：各级政府在区域卫生规划中加强对儿科床位的合理配置,适当增加县区级及以上医疗机构的儿科床位数,调整综合性医院内部床位设置,增加儿科床位比例。同时加强省市级儿童医院的建设,并加强各级医疗机构之间的分工和合作,完善基层机构和上级机构之间的双向转诊机制。     

如何降低三级医院床位使用率

针对三级医院床位使用率过高导致差错发生率高、院内感控难度大、医护人员工作负荷加大、医疗资源分配不均等问题,采取多项措施,通过合理控制床位使用率,促进医疗资源的有效利用和区域医疗资源的纵向流动,实现患者、医院、基层医疗机构的多方共赢.     

我国大型医院床位增长成因分析

近年,我国大型医院床位规模呈持续增长趋势,引发诸如国家医疗服务体系“正三角”结构遭到破坏、医疗费用上涨、优质资源稀释、骨干作用发挥不充分等一系列问题.本研究应用几何模型,将床位规模设为三角形面积,内外因素分别设为三角形的内切外接圆,供方、需方、举办方,分别设为床位规模扩张的作用方,制度因素、市场因素、需求因素和内部管理...     

多元办医格局下广西民营院发展现况研究[*基金项目：国家自然科学基金项目-广西公立医院改制重组模式及其优化路径的研究（8155605555）。 ①广西医科大学信息与管理学院 南宁 530021 # 通讯作者]*

目的 了解广西民营医院发展现状,为政府部门制定相关政策提供参考和建议。方法 通过文献研究和数据分析等方法,对来源于《中国卫生健康统计年鉴》、《广西卫生和计划生育年鉴》、《广西卫生和计划生育事业发展情况简报》和《广西卫生统计提要》等的医院数、床位数、卫生人力资源、门诊服务、住院服务和卫生资源利用指标进行统计学描述分析。结果 2008—2017年广西民营医院数由70家（15.56%）增加至259家（43.97%）;床位数由3 240张（2.74%）发展到20 723张（12.87%）;截止2017年底广西民营医院共有卫生人员10 976人, 占全区总人数的5.35%, 诊疗人次数达到552.91万人次,健康检查人数达到24.49万人次,入院人数达到43.83万人次,出院人数达到42.98万人次,住院病人手术人次数达到11.61万人次,病床工作日为229.7日,病床利用率为62.9%,平均住院日为9.4天,医师日均担负诊疗4.8人次,医师日均担负住院床日为2.6天。结论 广西民营医院存在发展速度较快但规模较小、卫生资源缺乏且利用率不高及缺乏核心竞争力等问题,应加大政府扶持力度,促进民营医院又好又快发展。