APPLICATIONS OF VITAL STATISTICAL INDICATORS OF DELIVERY OF HOSPITAL SERVICES

RATES AND RATIOS IN PUBLIC HEALTH

 Indicators for hospital services are computed for a given area
CASE 1 (designated catchment area)
Province Population CBR CDR IMR MMR No. of  Limitation: some patients come from outside the catchment area
Doctors  The indicators become more meaningful if they are estimated
A 300,000 28 12 65 3 28 for a wider area like a region (offsets the limitation)
B 300,000 32 13 66 2 30
INDICATORS OF THE VOLUME OF HOSPITAL SERVICES NEEDED
C 400,000 26 13 70 2 38
D 500,000 27 11 71 3 36
1. Admission or Discharge Rate
# of admissions/ discharges for a year x 1000
1.) Which province has the most number of babies born? D
Pop’n of the hospital catchment area
2.) Which province has the least number of babies born? A
3.) Which province has the most number of people dying? D
2. Hospitalization Rate
4.) Which province has the least number of people dying? A
Total # of in-patients during the year x 1000
5.) Which province has the most number of infant deaths? D
Pop’n of the hospital catchment area1
6.) Which province has the least number of infant deaths? A
3. Emergency Room Visit Rate
LIVE BIRTHS = Crude Birth Rate/1000 x Population
# of Emergency Room attendances for a year
You cannot use the crude birth rate per province as basis since the
Pop’n of the hospital catchment area
populations are different for each province. You will have to compute for
the actual number live births for each province.
4. Out-patient Consultation Rate
Province A = 28/1000 x 300,000 = 8,400 live births
# of out-patient consultations/ attendances for a year
Province B = 32/1000 x 300,000 =9,600 live births
Pop’n of the hospital catchment area
Province C = 26/1000 x 400,000 = 10,400 live births
Province D = 27/1000 x 500,000 = 13,500 live births
5. Consultation – Admission Ratio
Total out-patient consultations
DEATHS = Crude Death Rate/1000 x Population
Total admissions
You cannot use the Crude Death Rate per province as basis because the
populations of the provinces differ from each other.
INTERNAL HOSPITAL INDICATORS
Province A = 12/1000 x 300,000 = 3,600 deaths
 Measurements used to assess hospitals in terms of efficiency in
Province B = 13/ 1000 x 300,000 = 3,900 deaths
resource utilization, and to some extent, service quality
Province C = 13/1000 x 400,000 = 5,200 deaths
Province D = 11/1000 x 500,000 = 5,500 deaths
1. Average Duration of Hospitalization
# of bed-days utilized during the month or year
INFANT DEATHS = Infant Mortality Rate/1000 x Live Births
# of discharges during the month or year
Province A = 65/1000 x 8,400= 546 infant deaths
Province B = 66/1000 x 9,600 = 634 infant deaths
2. Average In-patients
Province C = 70/1000 x 10,400 = 728 infant deaths
# of bed-days utilized during the month or year
Province D = 71/1000 x 13,500 = 959 infant deaths
# of days during the month or year
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MATERNAL DEATHS = Maternal Mortality Rate/1000 x Live Births
Total # of daily census for the month or year
Province A = 3/1000 x 8,400 = 25 maternal deaths
# of days during the month or year
Province B = 2/1000 x 9,600 = 19 maternal deaths
Province C = 2/1000 x 10,400 = 21 maternal deaths
3. Bed Occupancy Rate (degree of utilization rate)
Province D = 3/1000 x 13,500 = 41 maternal deaths
# of bed-days utilized during the month or year x 100
(# of hospital beds) x (# of days of the month or year)
CASE 2
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Attack Rate
Disease No. of Cases No. of Deaths Average # of in-patients per day x 100
or CFR % Total bed capacity
Cholera 100 60 60
AGE 200 100 50 4. Turn-over Interval (performance per bed)
Pulmo diseases 300 150 50 Total # of beds available
Tetanus 400 200 50 Total # of discharges
Others 1000 500 50
Total Population of the town = 20,000 5. Average Number of Consultations per Patient
Total # of out-patient attendance
1.) Compare the killing power of tetanus with each of the causes. Total # of first-time consultations
Which one of the 4 would merit attention? Why?
6. Average Number of OPD Consultations per Day
Case Fatality Rate Total # of out-patient attendance
CFR = No. of deaths due to a particular cause x factor Total # of days the OPD is open
No. of cases of the same cause
Examine the following data excerpted from the report of a tertiary
 While cholera has 60% case fatality rate, it has only 60 deaths. hospital in July 2011:
The administrator is worried about the number of deaths.
Tetanus has the highest number of deaths. Bed capacity 500
 It merits more attention even though the CFR is 50% when Patients at beginning of July 420
compared with cholera which is 60%. Admitted 2,715
Discharged 2,707
2.) Compare the risk of dying from tetanus with the risk of dying from Patient-days of service 13,535
AGE; with the risk of dying from other causes. OPD 1st Consultation 6,788
Total OPD consultation 13,586
 Risk of dying comparison will be the death rate of specific cause. Total OPD days 27

Cause Specific Death Rate 1. Bed occupancy rate

No. of deaths due to a particular cause 13,535  (500 x 31 days) x 100 = 87%
CSDR = (defined place and time period) ______ x factor 2. Average stay in hospital
Total population (same place, time and period) 13,535  2,707 = 5 days
3. Average daily in-patient
Specific Cause Total deaths Total Pop. CSDR 13,535  31 days = 436.6 or 437 patients per day
Cholera 60 20,000 3/1000 4. 1st consultation – admission ratio
Gastroenteritis 100 20,000 5/1000 6,788  2,715 = 2.5 or 3; for every 3 consultation 1 is admitted
Pulmonary 150 20,000 7.5/1000 5. Average attendance per OPD case
Tetanus 200 20,000 10/1000 13,586  6,788 = 2; a patient is seen 2x for a particular disease
Others 500 20,000 51/1000 6. Average daily OPD cases
13,586  27 = 503 average OPD case
 Risk of dying from tetanus is higher than the risk of dying from
Cholera, gastroenteritis and pulmonary diseases. It is lower than
from other causes.
 POPULATION SIZE
POPULATION PROJECTION
NATURAL INCREASE
ARITHMETIC PROGRESSION METHOD
Given: Country X  Assumes that an equal amount of absolute change occurs in
No. of births in 2010 = 1,684,395 the population every year or that the population growth is
No. of deaths in 2010 = 319,579 the same as 10 years ago
Calculate for the Natural Increase in the population of Country X in
2010. Steps:
1. Determine the population of two censuses
2. Compute for the decennial increase
= 1,684,395 - 319,579 3. Divide this difference (step 2) by 10 (census years)
= 1,364,816 4. Multiply the result of step 3 with the number of years
projected from the last mentioned census
 A total of 1,364,816 persons were added to the population of
Country X in 2010. Example:
The population of a village X as per 1991 census was 5,000 and as per
2001 census 6,000. What would be its population on March 1, 2010?
RATE OF NATURAL INCREASE
Decennial increase (6,000-5,000) = 1,000
Given: Country X
Crude birth rate in 2010 = 25.8 per 1000 population The annual increase is 1,000 = 100
Crude deaths rate in 2010 = 4.9 per 1000 population 10
Calculate for the Rate of Natural Increase in the population of
The number of years from 2001 to 2010 = 9
Country X in 2010.
= 25.8/1000 - 4.9/1000
In the next 9 years = 9 x 100 =900
= 20.9/1000 population
The population on March 2010 = 6,000 (base population)
 There are about 21 persons per 1000 population through + 900
natural means were added to the population of Country X in 6,900
2010.

GEOMETRIC PROGRESSION METHOD

ABSOLUTE INCREASE PER YEAR • The population increases on the lines of a cash deposit
growing with compound interest.
Given: Province X • Assumes that population increase at a constant rate per
Population size, 1990 = 771,320 year.
Population size, 2000 = 1,150,458 • The principal mathematical operation therefore is the
Calculate for the absolute increase per year of Province X determination of the annual rate of population change.
population.
Let Pt = the population in 2010
r = annual rate of increase in %
= 1,150,458 - 771,320
10 Pt = Po (1 + r)t
= 37, 914
Example:
 Between 1990 and 2000, there were 37,914 individuals The population of a Village X as per 1991 census was 5,000 and as per
added to the population of Province X each year. 2001 census 6,000. What would be its population on March 1, 2010?

Task: Project the population of Village X in the year 2010 if the census
RELATIVE INCREASE in as per 1991 census was 5,000 and as per 2001 census was 6,000.

Given: Province X Solution:

Population size, 1990 = 771,320 To compute for the population in 2010, one can use either 1991 or
Population size, 2000 = 1,150,458 2001 census as the base population.
Calculate for the relative increase per year of Province X
population. Pt = the population in 2010
r = annual rate of increase in %

Compute for the rate of increase or change

Calculate for the relative increase per year of Province X = Census of 2001 – Census of 1991 ÷ time interval (yrs) x 100
population. Census of 1991
= 6,000 – 5,000 ÷ 10 years x 100
= 1,150,458 - 771,320 5,000
771,320 = 2%
= 379,138
771,320 Interpretation: The population therefore is increasing by 2% in a
= 49.2% compound interest fashion.

 The increase in the population size of Province X between 2001 population is = 6,000
2010 population is = Pt
1990 and 2000 is 49% of its original population that is, the
Difference in years = 2001 – 2010 = 9 years
1990 population.
Pt = 6,000 x (1 + .02)9

• Consulting the compound interest table, the value of 1

growing at 2% annually in 9yrs is 1.19509 or 1.1951.
• Hence the population at 2010 = 6,000 x 1.1951 = 7,170.6
• If the compound table is not available, use the computed rate
of increase (2%):
2 divided by 100 = 0.02
1 + 0.02 = 1.02
• And multiply 6,000 by 1.02 by nine times = 7,170.555 or
7,170.6

(in contrast to the computed 6,900 of the arithmetic method)