Retrospective analysis of use and distribution of resources in otolaryngology wards in Romanian hospitals between 2003 and 2008 to improve provision and financial performance of healthcare services.

Abstract

To analyze use and distribution of resources by otolaryngology (ENT) hospital wards in Romania between 2003 and 2008, in order to plan the improvement of patient access to health care services and health care services' financial performance. Clinical electronic records were searched for all patients discharged from all public hospitals funded on a per-case basis by the government between January 2003 and September 2008. Adult and pediatric ENT wards, as well as ENT wards from different counties, were compared. The number of ENT hospital beds and the number of specialists decreased from 2003 to 2004, the number of specialists declined, and specialists were distributed unevenly among the hospitals and counties. The total number of ENT wards was over 100 for almost the entire study period, but there were only about 15 pediatric ENT wards in all 42 counties. ENT wards recorded more cases and hospitalization days than oral-maxillofacial surgery and neurosurgery wards, but fewer cases than general surgery or obstetrics wards. ENT wards had the lowest mortality rates. Until the second half of 2007, adult ENT wards had a lower surgical index, higher complexity of cases, and longer average length of stay than pediatric ENT wards (P<0.001, t-test). After 2007, pediatric ENT wards treated more complex cases (P=0.004, t -test) that were less surgical in nature; this result was due to the shift from the Health Care Finance Administration classification diagnostic-related group (DRG) system to the Australian Refined DGR system, as well as to improper use of codes. ENT wards in different counties differed in the number of cases, average length of stay, and case mix index. Statistics and case mix clinical data may be a good starting point for informing hospital management to assess ENT service coverage, but they should be supplemented with data on hospitalization costs.