Dias de internación o estancia

Presento aquí un modelo para el cálculo de camas hosporitalarias que se estiman necesarias para atender la  demanda de la población. Según la propia OMS no existe un número determinado de camas, lo cnciual resulta lógico debido a la variabilidad epidemiológica y demográfica que cada país pueda tener. Si quisiera calcular el número de camas en Argentina, sabemos que (redondeando un numero aproximado ) 7 de cada 100 personas se internan por año, Este resultado es un promedio para todas las edades, y su elasticidad es baja, lo que resulta lógico, ya que a diferencia de las consultas médicas, que pueden ser autogeneradas por los propios médicos, o bien detenidas a través de listas de espera, se asume que la condición de alguien que se interna, es realmente porque lo necesita (aúnque esa eso es sólo en teoría, ya que muchos pacientes con problemas clínicos, solo en internados cuando se los puede atender en forma ambulatoria, o en su domicilio. Si a esto le sumamos un promedio de estadía de 5,5 días en el sector público (tomo éste sector porque es donde menos incentivos hay para la subprestación o la sobreprestación), desde ahi podriamos estimar un número de camas necesarias. Sabiendo además, que al menos un tercio de las internaciones, son gineco-obstétricas.
De este modo, una población de 100.000 habitantes, en Argentina, tendria una media de 7.000 internaciones por año, y divido este número por los días de estadía (LOS = long of stancy) nos acercamos a un número cercano a 1273 camas, que debo repartir en 12 meses, lo que me daria 106 camas, asumiendo un porcentaje de ocupación del 100%. Un número teórico que podría subestimar la cantidad de camas en un momento dado (por ejemplo ante una catástrofe), por lo que muchos prefieren determinar esto con un margen de error, de modo tal que para asumir un porcentaje de ocupación del 80% (que es un número alto), basta con una regla de tres simple, con lo que nos daría cerca de 127 camas. El modelo de organización del hospital es también una variable a tener en cuenta, aunque la norma es que la internación se realice por servicios y no por criterios de complejidad creciente, lo que estaría más acorde a lo que desde la APS se plantea.

Instrumento Cama. Calculos Y Estimaciones

Disease Management

Interventions to Improve Chronic Illness Care: Evaluating Their Effectiveness

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To cite this article:
Thomas Bodenheimer. Disease Management. June 2003, 6(2): 63-71. doi:10.1089/109350703321908441.

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Published in Volume: 6 Issue 2: July 5, 2004

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Full Text: • PDF for printing (110.3 KB) • PDF w/ links (170.7 KB)

Thomas Bodenheimer, MD

Department of Family and Community Medicine, University of California at San Francisco and San Francisco General Hospital, San Francisco, California. Tbodenheimer@medsch.ucsf.edu

Three overlapping initiatives can be found in the effort to improve the management of chronic illness: the report card initiative, the disease management industry, and "Improving Chronic Illness Care." The third of these initiatives proposes the Chronic Care Model to assist provider organizations in chronic care improvement. The Chronic Care Model is made up of six major elements: community resources, the health care system surrounding the provider organization, patient self-management, decision support, delivery system redesign, and clinical information systems. Within these elements are a number of components, for example, clinical practice guidelines, reminder prompts, disease registries, provider feedback systems, primary care teams, planned chronic care visits, and case management. A literature review is provided to summarize the effectiveness of these Chronic Care Model components.

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