Models for Estimating Psychiatric Bed Needs

Inland Counties Comprehensive Health Planning Council wished to estimate the psychiatric bed needs by type (such as state hospitals, board and care homes, etc.) in San Bernardino County from the distributions of patient arrivals and of lengths of stay. A statistical description of the system during 1973 was considered the first step toward estimating future bed needs. A computer simulation model using IBM\u27s programming language General Purpose Simulation System (GPSS) was developed and was found to be unsatisfactory. Theorems were then developed for a statistical model, seeking to predict future bed needs. The most convenient of these theorems states that under appropriate circumstances the average occupancy of a facility will be approximately equal to the product of (1) the average number of admissions per day and (2) the average length of stay in days. Generalizations of this theorem and the corresponding theorem for the variance of the number of occupants generated a model which predicted fairly accurately the occupancy of Ward B of San Bernardino County Hospital during the first six months of 1973. This statistical model is easily adaptable for changing conditions such as varying lengths of stay, decrease or increase in admissions, or changes in proportions of diagnoses

Prediction of mortality using dobutamine echocardiography

OBJECTIVES We sought to find out whether dobutamine echocardiography (DbE) could provide independent prediction of total and cardiac mortality, incremental to clinical and angiographic variables. BACKGROUND Existing outcome studies with DbE have examined composite end points, rather than death, over a relatively short follow-up. METHODS Clinical and stress data were collected in 3,156 patients (age 63 +/- 12 years, 1,801 men) undergoing DbE. Significant stenoses (>50% diameter) were identified in 70% of 1,073 patients undergoing coronary angiography. Total and cardiac mortality were identified over nine years of follow-up (mean 3.8 +/- 1.9). Cox models were used to analyze the effect of ischemia and other variables, independent of other determinants of mortality. RESULTS The dobutamine echocardiogram was abnormal in 1,575 patients (50%). Death occurred in 716 patients (23%), 259 of whom (8%) were thought to have died from cardiac causes. Patients with normal DbE had a total mortality of 8% per year and a cardiac mortality of 1% per year over the first four years of follow-up. Ischemia and the extent of abnormal wall motion were independent predictors of cardiac death, together with age and heart failure. In sequential Cox models, the predictive power of clinical data alone (model chi-square 115) was strengthened by adding the resting left ventricular function (model chi-square 138) and the results of DbE (model chi-square 181). In the subgroup undergoing coronary angiography, the power of the model was increased to a minor degree by the addition of coronary anatomy data. CONCLUSIONS Dobutamine echocardiography is an independent predictor of death, incremental to other data. While a normal dobutamine echocardiogram predicts low risk of cardiac death ton the order of 1% per year), this risk increases with the extent of abnormal wall motion at rest and stress, (J Am Coil Cardiol 2001;37:754-60) (C) 2001 by the American College of Cardiology