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[A measure of productivity in cardiology based on medical acts]
Insights
Hospital cardiology departments can assess efficiency using the Catalogue of Medical Acts (CdAM). This system quantizes medical procedures, revealing increased resource intensity in cardiology over time, particularly for complex interventions.
Area of Science:
- Cardiology
- Health Services Research
- Medical Economics
Background:
- Healthcare systems face resource constraints, necessitating efficiency assessments in hospital departments.
- Evaluating cardiology department productivity is crucial for optimizing resource allocation.
- The Catalogue of Medical Acts (CdAM) provides a framework for quantifying medical services.
Purpose of the Study:
- To evaluate and quantify the "products" of a cardiology department.
- To analyze changes in the production of cardiology services over time.
- To utilize the Catalogue of Medical Acts (CdAM) for assessing cardiology department output.
Main Methods:
- Comparative analysis of cardiology admissions in October 1987 (224 admissions) and October 1992 (209 admissions).
- Recording and weighting of all medical acts using the complexity/cost index (ICR), considering human, nursing, and technical resources.
- Calculation of total acts and total ICR for each study period: 1736 acts (24308 ICR) in 1987 and 1603 acts (32194 ICR) in 1992.
Main Results:
- A significant increase in the overall complexity/cost index (ICR) from 24308 in 1987 to 32194 in 1992.
- The rise in ICR is associated with an increase in invasive procedures, specifically interventional electrophysiology and haemodynamics.
- Case mix analysis revealed increased ICR per patient for angina, arrhythmias, and cardiomyopathy diagnoses between 1987 and 1992.
Conclusions:
- The Catalogue of Medical Acts (CdAM) effectively evaluates cardiologic activity, applicable in diverse healthcare settings like Italy.
- The complexity/cost index (ICR) quantifies the human and technical resource burden of medical acts.
- CdAM facilitates straightforward internal and external comparisons of departmental efficiency and activity.
Background:
The decreased availability of economic resources, opposed to the increased demand for medical assistance, requires the use of methods to assess hospital efficiency. Purpose of our study was to evaluate and quantify the "products" of a cardiology department, as well as the changes in time of their production, by means of a catalogue of medical acts, set up for the French health system (CdAM).
Methods:
The study includes the 224 admissions occurring in October 1987 and the 209 admissions of October 1992. Medical acts were recorded for all admissions, by number of acts as well as by weight of acts; this weight (expressed as complexity/cost index or ICR) takes into account the use of resources in terms of medical staff and nursing staff, together with technical resources, for each act. In 1987 and 1992, 1736 and 1603 acts were performed respectively, corresponding to a total weight of 24308 and 32194 ICR.
Results:
The increased ICR appears to be related to an increase of invasive procedures, particularly of interventional electrophysiology and haemodynamics. By considering case mix, we observed an increment of ICR for the diagnosis of angina (from 194.3 to 227.4 ICR per patient), of arrhythmias (from 178.0 to 273.1) and of cardiomyopathy (from 95.6 to 179.7).
Conclusions:
In conclusion, CdAM allows to evaluate the cardiologic activity also in the Italian situation; the ICR of each act permits to estimate the human and technical burden, with subsequent easy internal and external comparisons.