A Comparison Study of Outpatient Visits Forecasting
Effect between ARIMA with Seasonal Index and
SARIMA
Zhang Xinxiang Zhou Bo
School of Information & Safety Engineering, Zhongnan University of Economics and Law, Wuhan, China
Abstract—this paper delineates a case study analyzing and
forecasting of the outpatient visits frequency of a hospital in
Zhengzhou, China. By evaluating the annual out-patient data
throughout the year of 2015, this paper applies the ³DD\´
as timescale and carries out the experiment so as to forecast the
number of visiting patients with the impact of the ³WHHN´ taken
into consideration. Two models are used separately: the
Autoregressive Integrated Moving Average (ARIMA) with
seasonal index and the Seasonal Autoregressive Integrated
Moving Average (SARIMA). Based on the empirical findings
from the comparison of the fitting effect and forecasting effect of
the above two models, it is clear that SARIMA reaches a
satisfactory outcome: it displays optimum indexes. Therefore it is
preferable to deploy the SARIMA model to proceed a forecasting
of outpatient visits for medical institutions. Meanwhile the paper
also aims to provide management of medical institution with
theory grounds of working and personnel arrangement and
insight so as to make a prompt and reasonable contingency plan
when it comes to sudden disease.
Keywords: SARIMA Model; Outpatient visits; Seasonal index;
Forecasting
I. INTRODUCTION
Currently, how to make a reasonable allocation of medical
resources as well to deal with the sudden disease timely turn
out to be long-term challenges faced by the management of
medical institutions, given the rising tension and obvious
shortage of domestic medical resources[1]. Therefore, it is of
great practical and scientific significance to apply efficient
model and proceed to forecast the outpatient visits considering
the fact that the outpatient department constitutes a vital
position within the medical institutions.
In previous studies, many scholars home and abroad have
tried to apply various forecasting models to make analysis and
forecast with modeling based upon various outpatient data. For
example: Base on the time series model and subsequent
improvement [2],[3],[4];Base on the combination of models
and forecast[5]; Base on the comparison of forecasting effect
of models[6],[7]. Those researches mentioned above have all
chosen the ³Week´ or ³Month´ as timescale with regards to
data processing as the fitting effect could be better
demonstrated hence the most suitable models being used and
evaluated. Nevertheless, such loose timescales may not be
perfect choice considering short-term forecasting and the result
might fail to provide the manager of theory support of strategy
arrangement as well as monitoring of sudden disease. In view
978-1-5386-1978-0/17/$31.00 ©2017 IEEE

Fu Huijuan
of this problem, this paper selects ³Day´ as timescale which
prove to be precise forecasting of outpatient visits within short
period. Thus the forecasting result embodies both the alarming
and realistic meaning as to guide the administration personnel
to alter strategy and make accordingly arrangement. Cyclical
influence of the factor of the ³Week´ will be emerged due to
the reason that selected data has been narrowed down to ³GDLO\´
number, therefore it is appropriate to take seasonal index into
consideration. Combined time series model which has been
productively used in the field of forecasting research, ARIMA
with seasonal index and SARIMA are to be established. Via
the comparison of the fitting effect the two models present, the
optimal forecasting model shall be acquired so as to obtain the
more accurate forecasting of outpatient visits. 
II. METHODS
A. ARIMA Model with Seasonal Index
The Autoregressive integrated moving average (ARIMA)
model, a commonly used stochastic time series model, is one
of the classical model among time series models. Formulated
by Box and Jenkins[10], it works on a hypothesis that the
futuristic predicted values are linearly related to several
observations in the past and white noises as well. Therefore, it
is aimed at time series containing tendency. The model is
noted as ሺ’ǡ †ǡ “ሻ, p stands for autoregressive order, d
for moving average order, q for phase by order difference
order. Its formula is as follows:
 ɔሺሻ‫׏‬ୢ ›ሺ–ሻ ൌ  Ʌሺሻɂሺ–ሻ 
With
ɔሺሻ ൌ ͳ െ ɔଵ  െ ‫ ڮ‬െ ɔ୮  ୮ 
Ʌሺሻ ൌ  ͳ ൅ Ʌଵ  ൅ ‫ ڮ‬൅ Ʌ୯  ୯ 
‫׏‬ୢ ›ሺ–ሻ ൌ  ሺͳ െ ሻୢ šሺ–ሻ
In the formulaˈ ୩ is the lag operator of K; ‫ ׏‬is the
difference operator; ɔሺሻ is the autoregressive polynomial of
p with autoregressive parameter of ɔଵ , ɔଶ , 尀 , ɔ୮ ;  Ʌሺሻ
indicates moving average polynomial of q, as the moving
average parameter displayed as Ʌଵ ǡ Ʌଶ ǡ ‫ ڮ‬ǡ Ʌ୯ ; Stationary time
series reflects as ‫׏‬ୢ šሺ–ሻ ;  ɂሺ–ሻ reveals as mutually
independent sequences of white noise and obeys the Gauss
distribution.
The seasonal index method expatiates how the seasonal
periodic vibration of time series affecting the future
forecasting as a target. Multiplied the trending time series
which elicited via the ARIMA model with seasonal index, the
final forecasting model can be established. The formula for
calculating the seasonal index is shown below:
୫౟
Ƚ୧ ൌ ሺ‹ ൌ ͳǡ ǥ ǡ ሻ  
୑
In the formula, n is the total number of quarters asȽ୧ is
the index of Season ‹ . The average number of season ‹
presents as୧ as M is the average for the whole season. To
make the average of the seasonal index as 1, there is a need to
standardize the seasons, thus the formula sketches as below:
୬஑౟
Ƚෝన ൌ σ౤    ሺ‹ ൌ ͳǡ ‫ ڮ‬ǡ ሻ   ሺ͵ሻ
౟సభ ஑౟
According to formula (1) and (3), we can define the
ARIMA with seasonal index. It is as follows:
ɔሺሻ‫׏‬ୢ ›ሺ–ሻȽෝన ൌ  Ʌሺሻɂሺ–ሻ   ሺ‹ ൌ ͳǡ ‫ ڮ‬ǡ ሻ
B. SARIMA Model
Time series with obvious periodic vibration due to the
seasonal change (quarterly, monthly, and weekly etc.) could be
referred as seasonal time series. In order to deal with these
kinds of time series, we can adopt the Seasonal ARIMA Model,
namely the  ሺ’ǡ †ǡ “ሻሺǡ ǡ ሻୱ . in which p and P
signify the order of autoregressive and seasonal autoregressive
respectively; while d and D the order by difference and
seasonal difference, respectively; q and Q the order of moving
averages and seasonal moving average, respectively. Its
formula is as follows:
ɔሺሻ‫׎‬ሺୗ ሻ‫׏‬ୢ ‫׏‬ୈ ୗ
ୗ ›ሺ–ሻ ൌ ɅሺሻԂሺ ሻɂሺ–ሻ ሺͷሻ
there into
‫׎‬ሺ ୗ ሻ ൌ ͳ െ ‫׎‬ଵ  ୗ െ ‫ ڮ‬െ ‫  ୔׎‬ୗ 
Ԃሺ ୗ ሻ ൌ ͳ ൅ Ԃଵ  ୗ ൅ ‫ ڮ‬൅ Ԃ୯  ୗ 
‫׏‬ୈ ୗ ୈ
ୗ ൌ ሺͳ െ  ሻ 
B,‫׏‬, ›ሺ–ሻ, ɔሺሻ,Ʌሺሻ and ɂሺ–ሻ are consistent with the
ARIMA model with seasonal index. ‫׎‬ሺ ୗ ሻ indicates seasonal
autoregressive polynomial as‫׎‬ଵ ɾ‫׎‬ଶ ɾ ‫ ڮ‬ɾ‫ ୔׎‬acts as the
seasonal autoregressive parameter.  Ԃሺ ୗ ሻ stands for
seasonal moving average polynomial as Ԃଵ ɾԂଶ ɾ ‫ ڮ‬ɾԂ୕
act as seasonal moving average parameter;‫׏‬ୈ ୗ implies the
seasonal difference which goes through the D order.
Modeling and parametric estimation process is based on
the EViews statistics software.
C. Periodicity Analysis and Stability Test
The original sequence of time is counted by the time scale
of week and then variance analysis is being employed to see
how significant the impact of factor of ³:eek´ is. The
Original hypothesis (the effect of the factor of ³:eek´ is less
than significant) can be assumed as +Bį . If p-value
ሺʹሻ coming out of the test result (by default, accepting the
probability of original hypothesis, similarly hereinafter) does
not reach the significant level (0.05), then the original
hypothesis should be denied. That is, the effect the factor of
³:eek´ exerts on this sequence is clearly cyclical. Conversely,
the original hypothesis can be proved to be valid of which the
sequence is least affected by the factor of ³:eek´.
This paper uses ADF to perform the unit root test and
determine the stability of the original sequence, thus the
applicability of it and the compatibility it shows with the
model in this paper can be evaluated. The original hypothesis
of the ADF unit root test (Containing a unit root) is +Bį .
If the p-valve in the test results of the original time series is
less than the significant level (0.05), then the original
ሺͶሻ hypothesis is denied as there is no unit root and this time series
is representing the characteristics of stability. If the original
hypothesis cannot be denied, then a one by one order
difference re-test shall be operated until it is reached the
stability and being denied. If the original sequence cannot deny
the original hypothesis, then it is clear that this time sequence
is a unit root sequence which is not applicable for the model in
this paper.
In this paper, Eviews is used to analysis of variance of
time series and ADF unit root test.
D. ModelSelection Criteria
1) White Test
Due to the random error term of the model, if
heteroscedasticity exists, it will have an impact on the
forecasting accuracy of the model.
It is the white test is used that the heteroscedasticity can
be determined, thus the model being selected.
White test is to run a heteroscedasticity test using the
statistical quantity ofɖଶ which is constructed by means of an
auxiliary regression. For a model of random error term
sequences, if the original hypothesis is denied, then there is no
heteroscedasticity; if the original hypothesis is accepted, then
the very existence of heteroscedasticity can be proved, which
in turn shall affect the forecasting of the model, then the model
can be denied.
2) Criteria of ܴതଶ
ഥଶ is one of the important metrics of evaluating the fitness

of regression model with its values ranging from 0 to 1.The
closer the value is to 1, the better the effect of the fitting degree
of the model. Nevertheless, as the  ഥଶ criterion is used as a
measurement, one thing has to be considered that a minor
variable cannot be simply added to the model just upon the
basis of the increase of  ഥଶ as it could bring about a decrease in

the degree of freedom of the model. sequence, this paper adopts two models to deal with, namely
ഥଶ to
Thus this paper adopts an adjusting version of  the ARIMA model with seasonal index and the SARIMA
measure. It is noted as followsǣ model.

୬ିଵ
ഥ ଶ ൌ ͳ െ ሺͳ െ ଶ ሻ
   ሺ͸ሻ d>/͘ &ĂĐƚŽƌŽĨtĞĞŬ
୬ି୩ିଵ
Week IndexȽෝన
There into, n represents the sample size, and K represents
the number of explanatory variables. Such improvements can,
Monday 1.3234
to a certain point, avoid the effects of certain minor variables.
Tuesday 1.1018
3) Criteria of AIC and SC
AIC refers to the Schwartz criterion as SC refers to Wednesday 1.0579
Akaike information criteria and they are used to balance the
complexity of the estimated model and best result of fitting Thursday 1.0211
degree of the model. Both of the criteria share similar path of
thinking: The penalty factor is added to independent variable Friday 0.9838
within the model so as to reduce the influence it exerts upon
the model. Saturday 0.8428
Considering the model selection, it needs to be guaranteed
that the model has to pass the White test with largerഥଶ value Sunday 0.6692
and less than larger AIC and SC values.

III. MODEL BUILDING AND ANALYSIS 2) Stationary test
Two sequences, one adopts the first-order difference
A. Data Sources eliminating the factor of ³:eek´, another adopts the first
difference of seasonal difference are to build the ARIMA
The data in this paper are derived from the annual model and the SARIMA model separately. 
outpatient data of a hospital in Zhengzhou, Henan Province in The EViews software is used to draw their autocorrelation
the year of 2015. The data ranging from January to November (AC) and partial correlation (PAC) analysis charts (shown in
are selected as training data while the data of December are
Fig.2 Fig. 3). By observing and comparing autocorrelation,
picked as test data. The former is used to build the model while
partial correlation coefficients and their truncation cases,
the latter is used to evaluate the prediction effect of the model.
 ሺ͵ǡͳǡͳሻand ሺͳǡͲǡʹሻሺͳǡͳǡͳሻ଻ can be ascertained.
Fig. 1 is a plot of outpatient visits for the hospital from
January 2015 to November 2015.


Fig. 1.Time series plot of outpatient visits(01-01-2015 to 30-11-2015)

B. Model Building
1) Periodicity Analysis 
Variance analysis is performed after weekly outpatient
visits counting as the P value of the analysis results is far less Fig. 2.The plot of AC and PAC of series used by ARIMA
than 0.05.Therefore, it is considered that the factor of week has
exerted significant impact on outpatient visits and the sequence
shows a clear pattern of periodicity and S = 7.Table პ shows
the results of the factor of week (Ƚෝన ) quantified by the seasonal
index method. When it comes to the periodicity of the original


 Fig. 4. The comparison of forecasting and actual values

C. Model analysis and performance evaluation

Table ჟ reveals various basic statistical indicators of two
models. Viewing from the heteroscedasticity of the model, the
two models all passed the White testing which means the
random error sequence within the model has no variance. The
influence of heteroscedasticity on prediction accuracy can be
excluded. Seeing from the fitting degree of the model,
theഥଶ value of the SARIMA is greater than ARIMA with
seasonal index, indicating the superior fitting effect of
SARIMA. From the perspective of criteria of the AIC and SC
of the model and residual sum of squares, the statistics of
SARIMA are less than ARIMA with seasonal index.
d>//͘ ĂƐŝĐƐƚĂƚŝƐƚŝĐĂůŝŶĚŝĐĂƚŽƌƐŽĨŵŽĚĞůƐ
ARIMA with seasonal
Model SARIMA
index

 White test(P value) 0.0158 0.0002

Fig. 3. The plot of AC and PAC of series used by SARIMA
ഥଶ
 0.340441 0.379476
With the EViews being used to estimate the parameters of AIC 13.96273 13.73797
above models, the expression of the detailed models are as
follows: SC 14.01716 13.79183
The ARIMA with seasonal index:  residual sum of
23083039 19025094
ଶ ଷ ሻሺͳ squares
ሺͳ ൅ ͲǤͷʹʹʹ ൅ ͲǤ͵͸ͷ͵ ൅ ͲǤ͵ͳͺʹ െ

ሻ›ሺ–ሻȽෝన ൌ ሺͳ െ ͲǤʹ͵ͺʹሻɂሺ–ሻሺ‹ൌͳǡĂǡሻ    Table რ exhibits the forecasting performance of the two
models. By horizontal comparison, it is clear that all forms of
ሺ͹ሻ
error indicators of the SARIMA were less than the ARIMA
with seasonal index that the SARIMA model can better fit in
The SARIMA:  with the real value.
Meanwhile, Taken the correlation coefficient between
ሺͳ െ ͲǤͺ͸͵ʹሻሺͳ ൅ ͲǤͲͻ͵ͺ଻ ሻሺͳ െ  ଻ ሻ›ሺ–ሻ ൌ models and the real value into account, the statics shown of the
SARIMA (0.8627)is larger than the ARIMA with seasonal
ሺͳ ൅ ͲǤʹ͸Ͷ͵ ൅ ͲǤͳ͸Ͷ͸ଶ ሻሺͳ ൅ ͲǤͻͷͳͳ଻ ሻɂሺ–ሻ   index(0.8486), further testifying the better performance of the
ሺͺሻ fitting degree of the SARIMA model.
d>///͘ DŽĚĞůƉƌĞĚŝĐƚŝŽŶŽƵƚĐŽŵĞĂŶĚƉĞƌĨŽƌŵĂŶĐĞĞǀĂůƵĂƚŝŽŶ
Fig. 4 shows the comparison of the two models with the
ARIMA with
forecasting and actual values. days Real value SARIMA
seasonal index

Average

Absolute üü 172.65 169.26

Deviation(AAD)

Average Absolute

Relative üü 9.573% 9.310%

Deviation(AARD)

Mean Squared
üü 206.538 201.512
Error

correlation
üü 0.8486 0.8627
coefficient



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in the forecasting field. This paper has applied two models
separately expounding the outpatient visits: the ARIMA model 
with seasonal index and the SARIMA model. During the
research, the factor of ³Week´ has been taken into account. By
comparing and analyzing the experimental result with real data,
the quality of the model is being assessed and the conclusion
has been reached: the SARIMA model largely outweighs its
counterpart. It is believed that the SARIMA presents favorable
fitting effect of forecasting the future outpatient visits and
therefore the decision of future staffing arrangement can be
referred to and real time surveillance of disease shall be
ensured.
In addition to the factor of the ³Week´, there are many
other facets can influence the visiting number of outpatient in
real life, such as alteration of weather, season and environment
etc. As for the future research, the authors intends to add those
factors so as to improve and upgrade the forecasting model
with a more reliable and precise result with the aim to better
serve the medical institutions. 

ACKNOWLEDGMENT
The authors are grateful to the financial support from the N
ational Social Science Foundation of China (Grant No.16BGL
192). Furthermore, the study is a substantial work of the
Graduate Innovative Education Program of Zhongnan
University of Economics and Law (2017Y1411)

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