The problem of payment for short-term treatment in an inpatient emergency department: analysis and simulation modeling

Abstract

The purpose of the study: to conduct a clinical and economic analysis of the treatment effectiveness of the patients with a therapeutic profile, depending on the presence of an inpatient emergency department in the structure of the medical organization. Materials and methods. With the help of a retrospective analysis of 474 cases of hypertension worsening during the year, patients length of stay in the hospital, the amount of bills issued depending on the length of stay and the compliance of the conducted volume of examination with the requirements of the criteria for the quality of medical care were studied. Subsequently, using simulation modeling, a comparative analysis of the redistribution of patient flows was performed in order to identify optimal economic and logistical solutions. Results. When comparing the length of stay of patients, it was revealed that in 63.9% of cases, discharge occurred from dynamic observation beds during the first day. The analysis of compliance with the criteria for the quality of medical care showed that in the inpatient emergency department, almost the entire required amount of diagnosis and treatment is performed in a minimum period of time. If there is an inpatient emergency department in the hospital structure, the work model becomes significantly more intensive, but underfunded. Conclusion. The capabilities of inpatient emergency departments ensure short-term treatment of patients in compliance with the quality criteria of specialized care, while maintaining a large throughput compared to the therapeutic department. Based on the results obtained, the payment of cases should not be accompanied by the use of a sign of interruption of the case.