A stochastic network simulation model for the Texas certificate of need review process as relates to general hospital bed expansion

Abstract

A review of the literature related to hospital utilization as well as the Texas Certificate of Need (CON) process revealed no comprehensive, consistent method for reviewing CON applications. To overcome this deficiency in the Texas CON review procedures, a methodology is developed and presented which permits a consistent framework for the evaluation of hospital bed expansion requests. The model is designed around a stochastic network and employs the Generalized Network Simulator. The four component modules comprising the model are the Patient Flow Module, Manpower Analysis Module, Economic Analysis Module, and Existing Facility Impact Module. Each module serves to evaluate those criteria essential in exploring a Certificate of Need application. A primary goal of the research was to develop the methodology in such a manner that a user group would be able to easily employ the model. This objective has been obtained by structuring the input phase and output phase in terminology understood by potential user groups (e.g. the Texas Health Facility Commission, Health System Agencies). Additionally a users manual is presented as a guide for program use. Two case studies are examined using the methodology in order to test the program's ability to adequately evaluate expansion requests. Promising results were obtained in both instances, the details of which are presented in the research.