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Main
MATHEMATICAL MODELING IN PERFORMANCE MANAGEMENT OF MEDICAL ORGANIZATIONS PROVIDING INPATIENT CARE TO THE ELDERLY Print
Friday, 11 May 2018

DOI: 10.21045/2071-5021-2018-60-2-2

1,2Edeleva A.N., 1Starodubov V.I., 2Fedotkin M.A., 1Sabgayda T.P., 1Zaporozhchenko V.G.
1
Federal Research Institute for Health Organization and Informatics of Ministry of Public Health of Russian Federation, Moscow
2 Nizhny Novgorod State University named after N.I. Lobachevsky, Nizhny Novgorod

Contacts: Edeleva Anna, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Information about authors:
Edeleva A.N., https://orcid.org/0000-0002-8683-5185
Starodubov V.I., https://orcid.org/0000-0002-3625-4278
Fedotkin M.A., https://orcid.org/0000-0003-3102-1333
Sabgaida T.P., http://orcid.org/0000-0002-5670-6315
Zaporozhchenko V.G., https://orcid.org/0000-0002-6167-7379

Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.

Abstract

Rational use of limited health resources without decreasing medical effectiveness is relevant to the provision of inpatient care to the elderly with a high burden of chronic diseases, often accompanied by physical and mental problems. Within the context of the budgetary funding deficit, planning performance of the nursing care units, one should minimize expenditures related to the provision of comprehensive care. This can be done using optimization mathematical modelling.

Purpose: to analyze and manage performance of the nursing care units in hospitals based on the optimization mathematical model by the criterion of minimum financial expenditure.

Methods. Methods of operations research were used to analyze the structure of actual and optimal expenditure of the nursing care units in five multidisciplinary medical institutions of Nizhny Novgorod for the period from 2007 to 2015. Addressing the optimization problem of integer linear programming, the model limitations included a full capacity of the multidisciplinary medical institution with the nursing care unit.

For the analyzed year, the number of nursing beds was calculated if the number of treated patients was not lower than the actual number, and the number of deaths and the amount of financial resources spent were not higher than the actual figures. After that the optimal cost structure was determined across expenditure items. Calculations were made in the Microsoft Excel programme.

Results. The optimal total number of nursing beds in all five medical institutions in Nizhny Novgorod is lower than the actual number of beds in each year of the analyzed period. Optimal distribution of financial resources would have reduced the average number of beds by 30 in nine years. Setting the optimal numbers of beds and following the optimal structure of financial expenditures would have resulted in the total number of deaths decreased by about 32 people (32.2 %) for 9 years, the number of bed-days decreased by 11.5% and savings added up to 23.5%. With fewer occupied beds, inpatient care would have been provided to more elderly patients (more by 10 people).

Conclusion. Use of the optimization mathematical model by the criterion of minimum financial costs allows to develop recommendations for rational redistribution of resources to improve effectiveness of health care.

Distributions of actual and optimal costs across enlarged items of expenditure by the criterion of minimum financial expenditure hardly differ while the differences in medical and cost effectiveness are widely expressed. Comparison of the observed and optimal distribution of nursing beds allows to make a conclusion about performance of medical organizations. With effective performance of the medical organization, expenses under the enlarged items "Remuneration and payroll accruals" and "Other expenses" will gradually increase, while expenses and under the enlarged items "Acquisition of services, total" and "Acquisition of non-financial assets" will decrease.

Keywords: inpatient care to the elderly; nursing care units; nursing beds; expenditure structure optimization; static optimization mathematical model; optimization criterion.

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