Addressing Bed Costs for the Elderly: A New Methodology for Modelling Patient Outcomes and Length of Stay

The proportion of elderly in the population has dramatically increased and will continue to do so for at least the next 50 years. Medical resources throughout the world are feeling the added strain of the increasing proportion of elderly in the population. The effective care of elderly patients in hospitals may be enhanced by accurately modelling the length of stay of the patients in hospital and the associated costs involved. This paper examines previously developed models for patient length of stay in hospital and describes the recently developed conditional phase-type distribution (C-Ph) to model patient duration of stay in relation to explanatory patient variables. The Clinics data set was used to demonstrate the C-Ph methodology. The resulting model highlighted a strong relationship between Barthel grade, patient outcome and length of stay showing various groups of patient behaviour. The patients who stay in hospital for a very long time are usually those that consume the largest amount of hospital resources. These have been identified as the patients whose resulting outcome is transfer. Overall, the majority of transfer patients spend a considerably longer period of time in hospital compared to patients who die or are discharged home. The C-Ph model has the potential for considering costs where different costs are attached to the various phases or subgroups of patients and the anticipated cost of care estimated in advance. It is hoped that such a method will lead to the successful identification of the most cost effective case-mix management of the hospital ward.

Reflecting on Habitus, Field and Capital: Towards a Culturally Sensitive Social Work

Summary: This article argues that the notion of the knowledge base as a central aspect of professional activity is flawed, and that it is more useful to see social work as in a continuous process of constructing and reconstructing professional knowledge. Findings: Culture is an area that has attracted widespread attention in academia and the social professions. However, there has been little examination of culturally sensitive social work practice from a realist perspective, or one that starts from the view that oppressive structures, as encoded within social class, are essential determinants of cultural experience. Following a critique of postmodern perspectives on culture, the work of Pierre Bourdieu on culture and power is explored. Applications: Three of Bourdieu's key constructs - habitus, field and capital - are utilized to develop a model for culturally sensitive social work practice that attends to the interplay of agency and structure in reproducing inequalities within the social world.