Analysis of medical act processes using data of a hospital information system

本文利用高知大学医学院综合医疗信息系统数据库中的数据，对影响预约门诊患者候诊时间的因素进行了研究。结果，我们发现每位医生的平均会诊时间和每个预约时间框架内的患者数量平衡有重大影响。在此基础上，设计了一种基于每位医生每天平均就诊时间和每位医生每天总就诊人数、预约时间间隔、可接受的最大等待时间来确定每个预约时间框架的最佳就诊人数的方法。仿真结果表明，该方法确定的每帧最优患者数的病例可以有效缩短患者的等待时间。我们还分析了在住院期间哪些医疗行为的执行率较高，这些患者被分类为…更多到DPC（诊断程序组合）类别。我们将数据中的日期从每个患者的基本日期转换为相对日期。然后从属于同一DPC类别的所有患者中计算每个相对日的医疗行为发生率。在高比例的医疗行为中，住院后与出院前的实验室检查结果比较。在相对比值大于1的情况下，我们考察了这些检查是否可以作为显示恢复程度的指标。结果表明，对于外科病例，手术日期是最佳的基本日期，而不是住院日期或出院日期。对于内科病例，住院日期优于出院日期作为基准日期。在实验室检查和放射照相方面，每天的医疗行为分布出现了许多尖峰。这些日期被视为进行预定医疗行为的日期。另一方面，处方和注射剂的峰宽且连续。在实验室检查结果的比较中，我们发现几种检查对手术病例有统计学意义，可以作为恢复的指标。总胆红素、CRP、血小板、肌酐激酶；内科组CRP、淋巴细胞差异有统计学意义。少

We have investigated which factor affects in waiting time of the out patient with reservation by using the data extracted from a database of Integrated Medical Information System at Kochi University School of Medicine.As a result, we have found that the average consultation time of every physician and the balance of the number of patients in each reservation time frame have major influence. Based on the result, a method to decide the optimal number of patient for each reservation time frame by giving the average consultation time of each physician and total number of patient for every physician per day, time interval of a reservation time frame, the acceptable maximum waiting time have been devised.It has been shown by a simulation that the case by the optimal number of patients in each frame determined by this method could have shortened patients waiting time effectively.We also analyzed which medical acts were performed in high rate during a hospitalization for patients classified in … More to a DPC (Diagnosis Procedure Combination) category. We converted the dates in the data to relative dates from a basic date for each patient. Then the rates of medical acts performed on each relative day were calculated from all patients who belonged to the same DPC category.Among medical acts performed in high rate, laboratory examination results were compared between just after hospitalization and just before discharge. In the cases in which the relative ratios were significantly different from 1, we investigated whether those examinations could be used as indexes which show the degree of recovery.As a result, for surgical cases, the date of operation was the best date as the basic date compared with hospitalization date or discharge date. For internal medicine cases, hospitalization date was better than discharge date as the base date. In the case of laboratory examinations and radiography, the distributions of medical acts on each day showed many sharp peaks. They are considered as the dates on which scheduled medical acts were performed. On the other hand, broad and continuum peaks were found in the case of prescription and injections.In the comparison of laboratory examination results, we found that several kinds of examinations were statistically significant for surgical cases and could be used as the indexes of recovery. They were Total Bilirubin, CRP, Blood platelet and Creatinine kinase In the case of internal medicine, CRP and Lymphocyte were statistically significant.. Less