SPECIALIZED INPATIENT CARE IN CLUSTER HOSPITALS OF UKRAINE: A MULTICENTRE RETROSPECTIVE COMPARATIVE STUDY OF HOSPITALIZATION PATTERNS, BED UTILIZATION AND TREATMENT OUTCOMES

Abstract

Introduction. The performance of a cluster hospital depends on clinically justified admission, timely treatment, safe discharge and financial sustainability rather than maximal bed occupancy.Aim. To assess the results of patient-flow management at the Volodymyr Territorial Medical Association (Volyn region) and compare its trajectory with other cluster hospitals.Materials and methods. A multicentre retrospective comparative study for 2020–2025 included a nested before-after analysis at the index hospital. The local intervention was analytically formalised as an adapted “emergency front door-same day emergency care-specialty inpatient ward” model based on Same Day Emergency Care and Getting It Right First Time principles. Official hospital reports, open National Health Service of Ukraine data, national Form No. 20 and an external cluster-hospital benchmark were used. Outcomes included admissions, bed-days, length of stay, occupancy, bed turnover, surgical activity and nominal and real payments. The seven-hospital panel comprised 483 hospital-months; fixed-effects modelling with Driscoll-Kraay standard errors was applied.Results. In the first half of 2022 versus the first half of 2021, length of stay decreased from 8.5 to 7.3 days and bed-day intensity from 850.0 to 728.0 bed-days per 100 patients; the counterfactual estimate indicated 5,187 bed-days released, while surgical activity increased from 47.2% to 61.0%. Following capacity expansion in 2023, admissions increased by 32.4%, but occupancy decreased from 62.7% to 52.1%. In the first half of 2025, process drift was observed: length of stay increased from 7.2 to 7.9 days. Between 2020 and 2025, inpatient volume increased by 110.2% and nominal revenue from the National Health Service of Ukraine by 237.5%. The adjusted real payment ratio for Volodymyr was 1.42, and the relative change versus six peer hospitals was 1.58.Conclusions. The management model produced an early reduction in unnecessary bed-day intensity and strengthened the hospital’s relative financial position, but the effect was not linear. The next stage should include diagnosis-specific pathways, daily criteria to reside, return and readmission monitoring, and episode-level costing.