Physician Staffing for the VA Volume I (1991) / Chapter Skim
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8 - PROJECTING FUTURE PATIENT WORKLOAD
8 - PROJECTING FUTURE PATIENT WORKLOAD
Pages 321-342
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From page 321... ...
Consistent with the VA's original request to the Institute of Medicine, the committee determined that its methodology should be capable of taking into account projected changes over time in the volume and case mix of workload resulting from the aging of the veteran population (Institute of Medicine, 1987~. The methodology also should be flexible enough, in the comm~ttee's view, to incorporate the influence of other factors possibly affecting workload, such as the proportion of females in the veteran population or the distribution of veterans across eligibility-for-care categories.
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From page 322... ...
Under either expert judgment approach, ambulatory workload must be projected by specialty clinic within ambulatory PCAs. The main purpose of this chapter is to describe and briefly illustrate how these workload projections can be derived.
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From page 323... ...
It is not difficult, in concept, to derive independent projections for the SADI or the DSE workload variables, but additional data collection and analyses would be required. · The sequence of steps to derive workload projections from any of the models below is similar.
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From page 324... ...
INPATIENT WORKLOAD This discussion focuses on the derivation of inpatient workload projections required for the EBPSM. A procedure for obtaining workload projections for the expert judgment models is presented subsequently.
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From page 325... ...
In applications involving the inpatient psychiatry PF equation in chapter 4, BDOC in the psychiatry inpatient PCA is assumed to grow over time in proportion to total WWUs there. Projection Model The basic equation underlying the inpatient workload projection model is WWUs = (WWUs/Discharges)
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From page 326... ...
where the sum is across the six inpatient PCAs, and k is now properly interpreted as one of the six physician specialties linked expressly to an inpatient PCA (medicine, surgery, psychiatry, neurology, rehabilitation medicine, and
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From page 327... ...
It uses BDOC/Discharges rather than the WWUs/Discharges found in Equation 8.1 and thus expresses workload in terms of patient days rather than WWUs. Both the VA model and the one proposed here produce workload projections based on the projected age-adjusted veteran population.
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From page 328... ...
Since these rates do not continuously increase or decrease, the projected discharge rate is computed as the overall average of the three, which turns out to be 0.066109. The projected veteran population for the 75+ age group in the PSA associated with VAMC II for FY 20C)
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From page 329... ...
Thus, the VA decision malcer is in no position currently to apply analogues of the workload projection formulas shown above in Projections for the EBPSM~ to obtain direct estimates of such SADI or DSE inpatient workload variables as average daily census (AD C) by ward, admission rates by PCA, various physician-performed procedures, and consultations to other inpatient PCAs.
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From page 330... ...
, the projection of which is an intermediate product in the workload formula Equation 8.1'. The daily admission rate for the inpatient medicine PCA at VAMC II in FY 1989 was 15.2.
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From page 331... ...
Subsequently, a procedure for using these to derive projections for the expert judgment approaches is discussed. Projections for the EBPSM The ambulatory care workload variable that, with one exception, performed best overall on statistical and clinical criteria in the estimated equations of chapter 4 was the Capitation Weighted Work Unit (CAPWWU)
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From page 332... ...
where CAPWW[li~ 19~9 a Clinic stopsij 1989 a Clinic-Stop Rateij``, Vet P°Pita total PCA j CAPWWUs generated by age group a atVAMCiinFY1989; the number of age group a visits to clinic stops associated with PCA j at VAMC i in FY 1989; the projected number of PCA j clinic-stop visits generated by age group a at VAMC i in FY t, divided by the projected age group a veteran population size in the PSA associated with VAMC i in FY t; the projected age group a veteran population for the PSA of VAMC i in FY t. The ambulatory PCAs are medicine, surgery, psychiatry, neurology, rehabilitation medicine, and other physician services.
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From page 333... ...
The model summarized in Equation 8.4' differs from the existing VA outpatient workload model in several respects. The latter generates workload projections in terms of "patient visits for the entire VAMC, disaggregated into several broad categories: compensation and pension examinations, applications for care, five distinct categories of mental health visits, and a residual category for "other" types of visits.
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From page 334... ...
to obtain a projected value for CAPVVWU`j,, the key ambulatory care workload variable. The calculations all pertain to the ambulatory medicine PCA at VAMC II and to FY 2000.
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From page 335... ...
(A caveat again is that the aging of the veteran population may lead the visit rate for the PCA no' to be proportional to its total CAPWWU score; for instance, the latter may grow faster than the former.) LONG-TERM CARE WORKLOAD As before, the workload projection method for the EBPSM is examined first, then extensions of the analysis that yield (indirect)
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From page 336... ...
RUGWWU`j~ 1989,a = total RUGWWUs associated with specialty k generated by age group a in long-term care PCA j of VAMC i in FY 1989; DiSChargeSl', 1989, a Discharge Rate Vet Pop`= the number of age group a discharges in FY 1989 from PCA j of VAMC i; the projected number of age group a discharges from PCA j of VAMC i in FY t, divided by the projected age group a veteran population size in the PSA associated with VAMC i in FY t; = the projected age group a veteran population for the PSA of VAMC i in FY t. The LTC PCAs are the nursing home and intermediate care.
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From page 337... ...
as MEDRUGWWUi,. The LTC workload variables for psychiatry and rehabilitation medicine are constructed similarly.
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From page 338... ...
The projected discharge rate in Equation 8.5' is computed from the three most recently available historical rates via "trending rules" identical to those used for deriving the projected discharge rate for inpatient PCAs (see Using VA Data to Assign Value to the Variables under Inpatient Workloads above)
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From page 339... ...
Under either expert judgment approach, the same types of workload variables relevant to assessing physician requirements for the inpatient PCAs apply, as well, in the LTC PCAs: ADC, admission rates, physician-performed procedures (e.g., swan ganz catheter, spinal tap, nasogastric tubes) , and consultations to other PCAs.
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From page 340... ...
Given the expected growth of the age 65+ veteran population, this excess demand is likely to persist for years unless the VA rapidly increases the number of nursing home beds. This issue is important to the interpretation of the LTC workload projection model.
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From page 341... ...
On the other hand, if the VA significantly increases its supply of nursing home beds, the workload projection model would have to be modified accordingly. This could involve reassessing both the projected discharge rate and the projected RUGWWUs per discharge, since the (age-specific)
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