[A measure of productivity in cardiology based on medical acts].
BACKGROUND
The decreased availability of economic resources, opposed to the increased demand for medical assistance, requires the use of methods to assess hospital efficiency. Purpose of our study was to evaluate and quantify the "products" of a cardiology department, as well as the changes in time of their production, by means of a catalogue of medical acts, set up for the French health system (CdAM).


METHODS
The study includes the 224 admissions occurring in October 1987 and the 209 admissions of October 1992. Medical acts were recorded for all admissions, by number of acts as well as by weight of acts; this weight (expressed as complexity/cost index or ICR) takes into account the use of resources in terms of medical staff and nursing staff, together with technical resources, for each act. In 1987 and 1992, 1736 and 1603 acts were performed respectively, corresponding to a total weight of 24308 and 32194 ICR.


RESULTS
The increased ICR appears to be related to an increase of invasive procedures, particularly of interventional electrophysiology and haemodynamics. By considering case mix, we observed an increment of ICR for the diagnosis of angina (from 194.3 to 227.4 ICR per patient), of arrhythmias (from 178.0 to 273.1) and of cardiomyopathy (from 95.6 to 179.7).


CONCLUSIONS
In conclusion, CdAM allows to evaluate the cardiologic activity also in the Italian situation; the ICR of each act permits to estimate the human and technical burden, with subsequent easy internal and external comparisons.
Klersy
C
C
Divisione di Cardiologia, IRCCS Policlinico San Matteo, Pavia.
Raisaro
A
A
Pani
A
A
Pistorio
A
A
Giraldi
M
M
Tinelli
C
C
Curti
M
M
Montemartini
C
C
Solcia
E
E
D016507:Cardiology Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups / Q000458:organization & administration / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000706:statistics & numerical data; D005602:France; D006295:Health Resources / Q000706:statistics & numerical data; D006753:Hospital Records / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D009732:Nursing Care / Q000706:statistics & numerical data; D014481:United States
Una misura di produttività in cardiologia basata sugli atti medici.