Performance comparison in geriatric medicine: a study in one department

Area of Science:

• Geriatric Medicine
• Health Services Research
• Mathematical Modeling

Background:

• Performance comparison in healthcare is common but challenging in geriatric medicine due to complex factors like case mix and discharge destinations.
• Traditional methods like Barber-Johnson diagrams are not ideal for specialties with long patient stays.
• Existing simple statistics may not adequately capture performance variations among consultants.

Purpose of the Study:

• To compare the performance of five consultants within a geriatric medicine department using mathematical models.
• To identify performance differences that are not evident through standard statistical analyses.
• To explore the utility of mathematical modeling in assessing consultant productivity in geriatric care.

Main Methods:

• Utilized a Monte Carlo simulation based on historic-frequency tables to estimate annual admissions.
• Employed a two-compartment flow model analyzing average bed occupancy to predict patient throughput.
• Compared consultant performance based on model outputs for annual admissions and patient length of stay.

Main Results:

• Monte Carlo simulation predicted annual admissions ranging from 592 to 748 across five consultants.
• A two-sample t-test indicated only two consultants had statistically similar performance.
• The two-compartment flow model predicted 650 to 856 annual admissions and identified differences in how two consultants managed longer-stay patients.

Conclusions:

• Mathematical models successfully identified significant variations in consultant performance in geriatric medicine, surpassing simple statistical methods.
• The models highlight areas of variation, facilitating further discussion on clinical and operational factors influencing performance.
• Routine data collection needs improvement to fully interpret the causes of observed performance differences in geriatric care.