STRENGTHS AND WEAKNESSES
( 3th and last part )

SISA may be analysed according to two basic points of view: a statistical one and an epidemiological one.

1) The Statistical Information Service gathers and analyses the data of the population and of healthcare production activity, it produces data for management control, for the evaluation unit, for managers on various levels, etc. The goal of this activity is to supply an account of the populations’ state of health, through an analysis of the hospitalisation requests and causes by district and/or by town and by sex, and an account of the financial/organisational management of the enterprise.

The indicators and tables that emerge from such analyses are:
a) Study of the population by town and district:
Town District Population Percentage Total
b) Study of the population by district, sex and age:
District Sex 0-13 years 14-64 years 65-74 years > 75 years TOTAL male female total Enterprise Total
c) Hospitalisation requests by town and sex:
Town Male Female Hospitalisations % Total
d) Hospitalisation percentage by town:
Town Populatio Hospitalisations % Total
e) Overall cost of company management;
f) Overall per capita cost of company management:
Overall Cost Population
g) Per capita cost of corporate staff:
Corporate Staff Expenses Population
h) Per capita cost of staff by district:
District X Staff Expenses District X Population
i) Per capita allocation of pharmaceutical expenses:
Total pharmaceutical expenses Population
j) Overall cost by day spent in hospital: Overall Cost Days Spent in Hospital
k) Average cost of role X staff :
Role X Staff Expenses No. of Role X Employees
l) Cost of pharmaceutical products and blood derivatives per day spent in hospital:
Expense for Pharmaceutical Products and Blood Derivatives Days Spent in Hospital
m) Bedspace utilisation rate:
Days Spent in Hospital Bedspace
n) Average stay in hospital:
Days Spent in Hospital No. of Patients Discharged.
o) Patients discharged per employee
No. of Patients Discharged Total Number of Employees
p) Staff members per bedspace Staff Members Bedspace
q) total number of working hours;
r) number of overtime working hours;
s) number of hours due.

2) The Epidemiologic Information Service gathers and analyses the data relating to healthcare demand, disease spreading, mortality, morbidity, etc. On the other hand, the goal of this activity is to provide an account of the populations’ state of health, through an analysis of the hospitalisation requests and “causes”, the pathologies and their frequency, based on the hospital discharge sheets. The objective is to find out whether significant differences exist between the data observed in the towns used as a reference and the expected data, and - should this be the case - establish the reasons thereof.

The indicators and tables that emerge from such analyses are:
a) Patients discharged, by sex and age.
HOSPITALISATIONS DAYS OF STAY SEX AGE BRACKETS IN HOSPITAL M F 0/6 7/18 19/25 26/36 36/50 51/70 > 70 Ordinary D. H. TOTAL AVERAGE STAY IN HOSPITAL = DAYS OF ORDINARY STAY / ORD. HOSPITALISATION
b) Patients discharged, by provenience area and region:
OTHER REGION PROVENIENCE P.O.1 P.O.2 P.O.3
TOTAL PATIENTS DISCHARGED
PIEDMONT
LOMBARDY
AUTONOMOUS PROV. OF BOLZANO
AUTONOMOUS PROV. OF TRENTO
VENETO
FRIULI
VENEZIA GIULIA
LIGURIA
TUSCANY
UMBRIA
MARCHES
LATIUM
ABRUZZO MOLISE
CAMPANIA
APULIA
BASILICATA
CALABRIA
SICILY
SARDINIA
HOSPITALISATIONS FROM OTHER COUNTRIES
TOTAL
OTHER REGION PROVENIENCE
TOTAL PATIENTS DISCHARGED
AS 1 PAOLA
AS 2 CASTROVILLARI
AS 3 ROSSANO
AS 4 COSENZA
AS 5 CROTONE
AS 6 LAMEZIA TERME
AS 7 CATANZARO
AS 8 VIBO VALENTIA
AS 9 LOCRI
AS 10 PALMI
AS 11 REGGIO CALABRIA
TOTAL
c) Analysis of pathologies
MDC DESCRIPTION N. of cases Total stay Average stay % N. of cases
1.Diseases and disorders affecting the nervous system
2.Diseases and disorders affecting the eyes
3.Diseases and disorders affecting ears, nose, mouth and throat
4.Diseases and disorders affecting the respiratory system
5.Diseases and disorders affecting the cardiovascular system
6.Diseases and disorders affecting the digestive apparatus
7.Hepatobiliary and pancreas diseases and disorders
8.Diseases and disorders affecting the skeletal- muscle and connective tissue system 9.Diseases and disorders affecting the skin, subcutaneous connective tissue and breast 10.Endocrine, nutritional and metabolic diseases and disorders
11.Diseases and disorders affecting kidneys and the urinary tract
12.Diseases and disorders affecting the male reproductive system
13.Diseases and disorders affecting the female reproductive system
14.Pregnancy, delivery and post-partum stay in hospital
15.Diseases and disorders relating to the neonatal period
16.Diseases and disorders affecting blood, haemopoietic organs and the immune system 17. Myeloproliferative diseases and disorders andscarcely differentiated neoplasias 18.Infectious and parasitical diseases (either systemic or concerning non-specific seats) 19.Mental diseases and disorders
20.Alcohol/drug abuse and mental and induced organic mental disorders
21.Traumatisms, poisonings and and drug-related toxic effects
22.Burns
23.Factors influencing the state of health and the resort to healthcare services 24.Significant multiple traumatisms
25.Unclassified DRGs (Diagnosis Related Groups)
GRAND TOTAL BY M.D.C. (Major Diagnostic Category)
d) Case-mix index for rating the complexity of the case record treated:
e) Performance index: where:
ag = relative specific weight for each DRG;
dg = days of stay in hospital for each DRG;
Ngh = number of patients discharged within the DRG in each health institution;
Ngr = number of patients discharged within the DRG in a specific Region (or ASL); 492 = overall no. of DRG classified in the IDC-9-CM list.

The complexity of the case record treated is rated by calculating the ratio between the makeup of the case record treated in each health institution, weighted by means of the DRG relative weight system, and the weighted makeup of case record treated within all the health institutions operating in the Regional Healthcare System.
The case-mix index expresses the relative complexity of the case record treated by the department or institution in question compared to the reference standard datum; its value is above 1, when the department or institution deals with a more complex case record compared to the one relating to the reference standard. Performance is rated by calculating the weighted ratio between the number of days of stay in hospital for the case record treated in each health institution and the number of days of stay in hospital for the case record treated within all the health institutions operating in the Regional Healthcare System.
This comparative index expresses the relative performance for the department or institution in question compared to the reference standard datum; its value is below 1, when the performance of the department or institution is higher compared to that of the reference standard. (12).

Closing Considerations

We may positively state that, as part of the corporate information system development course, a major transition has taken place: a switch from a manual management to a cybernated management of information.
The strong drive coming from the outside environment is forcing on enterprises in general, and on healthcare enterprises in particular, the achievement of two objectives: - the availability of a system capable of developing, together with corporate processes, as regards the production of useful information; - the possibility of supplementing the outside corporate dimension, as well as the inside one.
The first aspect is linked to the fact that the business dynamics are such that it is impossible for an integrated information system to have, amongst its properties, that of managing to easily model itself depending on the changes that have taken place in processes carried out by the company. The other objective relates to the need to attain a further integration of the healthcare enterprise, meant as a planning and production nucleus, with the facilities making up its logistic chain as regards the supply of goods and services, as well as user satisfaction.
In this situation, the development of an adequate information system represents the first essential stage for the attainment of efficiency and effectiveness objectives in the employment of the resources available. In other words, a well organised and effective information system represents the necessary support for the healthcare enterprise government and coordination functions, since it represents the basic condition required to make the various professional positions aware of their responsibilities with respect to managerial processes (by increasingly decentralising decisional processes at a more operational level) and to carry out an effective management control at an operational, management and strategic level. (traslation by Interpres)

Ubaldo Comite
Professore a contratto
Cattedra di Organizzazione Aziendale
Università della Calabria