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Common measures of health service provision and usage

Applications: Common measures of health service provision and usage

Access:

Average time for an ambulance to arrive from call time. Indicates whether ambulance provision  reflects needs of the population given its distribution.

General Practice provision:

Either  (whole time equivalent) doctors per 1000 population or (equivalently) average list size per whole time equivalent doctor. Mapped over a region this can be useful in identifying under-provided areas. 

Time to first GP appointment. Has been used as measure of provision, but is really more of an indicator of management effectiveness.

Hospitals provision:

Hospital doctors per 1000 catchment population. Beds/1000 catchment population. Both depend on the notion of a 'catchment population' which has rather vanished with the advent of commissioning. Catchment could be replaced by Commissioned-for.

Time to first routine elective admission, ie, routine waiting list admission. This is a good indicator if the system is left to operate as a pure queuing process, but waiting times are a major political football, and various wonders have been wrought with them without providing additional capacity, which again suggests an element of management effectiveness rather than a measure of provision.

Time from fit for discharge to actual discharge of an elderly person.  This is a good indicator of provision of support care in the community.

General and community provision:  any service many be measured in terms of the wte staff or other resources available to it, using the appropriate population as denominator (eg district nurse wte/100 under 5 year olds).

Hospital Usage:

Outpatient Did Not Attend (DNA) rates.  Indicate proportion of booked appointments not attended, so measure of utilisation of clinics.  However, most hospitals intentionally overbook outpatient appointments to minimise this effect.

Bed occupancy: the ratio of occupied bed days to the days the bed is available for use.  To enable adequate cleaning between patients, and to avoid placing patients in unsuitable beds (eg wrong specialty) this should generally not go above 85%. However,  occupancy in excess of 90% is not unusual, and contracts specifying 95% are not unknown. Such high occupancy places serious strain on the ability of the hospital to cope. Closely related measure: turnaround time, the average time between one patient being discharged from a bed and another patient being admitted to it.

Theatre utilisation: the proportion of scheduled operating theatre time that is actually used for surgery.

© M Goodyear 2008