The research presented in this thesis focuses on the investigation of whether the compartmental flow models of bed occupancy originally described by Harrison and Millard (1991) for decision-making around geriatric service care in the English
National Health Service can be used to describe data from acute care hospitals in Australia and New Zealand.
Australia’s total health expenditure for 2004-05 was $87.3 billion. The use of health care services and expenditure pattern is well established and Australia follows the pattern found in most developed countries, with the greatest expenditure occurring on services for the elderly. Australia is experiencing a shift in population structure, with the proportion of older people forecast to increase. It is expected there will be a need for a greater level of expenditure on health care as the number of elderly people increase.
There is an emerging gap between the ability to supply health services and the demand for them. Furthermore, acute care hospital treatment is generally considered expensive and governments have been keen to control this expenditure.
It is imperative that governments are able to make decisions based upon robust policy advice. There are serious consequences in both economic resource allocation and patient (and population) health outcomes if decisions about future health service structures are incorrect. In particular, there is a need for better decision-making around bed management at the strategic level. Strategic decision-making relates to decisions that will occur in a longer time frame.
Decision-making can benefit from the use of modelling. Models represent a simplified version of reality that preserve the essential features of the situation being examined and can be used as a tool to investigate decision-making options, particularly in complex environments such as the health sector.
Historically decision-making relating to hospital beds has used either simple “back of the envelope” calculations or adherence to “rule of thumb” approaches. Most of the approaches have relied upon using the average length of stay metric. While the modelling of hospital bed numbers is not new, much of this work has relied upon the average length of stay, which is known to be a poor measure.
Harrison and Millard (1991) introduced the application of the compartmental flow model for modelling hospital bed occupancy and noted its potential to be used to influence policy decision-making. The flow model results are plausible and easily interpreted. However, relatively little work has focussed on the ability of these models to be generalized and be used for predictive purposes.
The research undertaken for this thesis consisted of a series of modelling experiments that can be grouped into two key stages: whether the models could be successfully applied to the acute care data; and whether the models could be used for novel purposes, such as forecasting, evaluation of service change, and benchmarking. This entailed the further development of the model, and a consideration of basic modelling issues such as the balance between data-fit and model complexity, in order to capture better variation in the data and also to facilitate linkage to changes in population and seasonality. http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1301698 Thesis(Ph.D.) -- School of Psychology, 2007