Adjusting planning guidelines for cardiac-care units

The principal concern of this paper is the development of procedures for adjusting the criteria currently being used for federally-legislated health planning activities. These procedures would enable the planner to account for the demographic, geographic and health-system conditions which cause variations in the need for health-care services in local communities. A case-mix method, hospital chart-abstract data and demographic, geographic and health-system data from New Jersey were used to: create a list of diagnoses eligible for treatment in a Cardiac-Care Unit (CCU); select a sample of hospitals for study, and conduct a step-wise regression analysis of CCU utilization in these hospitals. It was concluded that CCU utilization was affected by factors such as the in-hospital availability of CCU beds, the type of hospital, CCU-patients' clinical severity, and the availability of ambulances and mobile intensive care units. Procedures for adjusting planning criteria to account for local conditions have yet to be developed. However, a method for using the types of results presented in this paper to develop such adjustment procedures was presented and illustrated. It is recommended that this method be used to create such adjustment procedures for the planning criteria for all hospital services and hence to assist Health Systems Agencies in rationalizing the distribution of our hospital care.