Gráficos de recorrência e de poincaré na análise da quantidade de internações por diferentes grupos nosológicos, ocorridas ao longo de uma década, em um hospital de ensino

Abstract

In the last 30 years, the increasing health care expenditures resulted in an outburst of studies aimed at new proposals on the methodological evaluation of health services. With the aid of computing, several studies have been developed with the purpose of analyzing nonlinear and complex systems. The most outstanding among those methods was the Recurrence Plot, first described by Erickman et al. (1987).Objectives: To analyze the temporal behavior of the weekly amount of admissions by some nosologic groups (Appendix Diseases, Bacterial Diseases, Neoplastic Disease, and Acute Coronary Syndrome), which has occurred over a decade, through Recurrence Plots and Poincaré Recurrence Plots, as well as checking whether the systems are presenting a periodic, chaotic, or random behavior pattern. Material and Methods: The database containing all hospitalizations recorded at the Hospital de Base Regional Medical School Foundation (FUNFARME) of Sao Jose do Rio Preto, a teaching hospital, from January 1, 1998 to December 31, 2007 was peered into a microscope. As a reference to classify all these admissions, the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) was used. The Microsoft Office Excel 2003® was the software used to arrange the data into columns. The admissions were systematically set to the right array, such as day, month, and year. They were arranged into columns according to the uniform criteria of identification of the epidemiological weeks. The recurrence graphs and the respective quantitative analyses of recurrence were developed with the aid of the Visual Recurrence Analysis (VRA) software, which is freely available on the Internet. To perform the comparison among the behavior patterns, mathematical models of time series for random behavior pattern, series time for chaotic behavior pattern, series times for periodic behavior pattern, and series time for linear behavior pattern were constructed. And it has also been performed a comparison between the Recurrence Plots and the Quantitative Analysis of Recurrence with clinical cases of specific groups (young, adult, child, premature newborn, and brain death).Results: It has become clear that the number of weekly admissions for diseases of the appendix has had a tendency over the years from a random behavior pattern. In hospitalizations due to bacterial diseases, there was a chaotic behavior pattern and the neoplastic diseases showed a chaotic behavior pattern tending to a linear behavior pattern. Hospitalizations because of Acute Coronary Syndrome presented a predominantly linear behavior pattern. Conclusions: The visual aspects of Recurrence Plot and Poincaré Recurrence plot exhibited different patterns when comparing quantities of admissions of certain nosologic groups over a decade. The quantitative analysis of recurrence that was useful in classifying the behavior pattern of the quantities of admissions is likely to constitute a useful tool of evaluation and decision making regarding hospital administration.