Assessing the Appropriateness of Hospital Utilization: Medical Admissions and Days of Care | ||||
| Journal of High Institute of Public Health | ||||
| Article 5, Volume 32, Issue 2, April 2002, Page 263-282 | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/jhiph.2002.207809 | ||||
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| Author | ||||
| Hoda Z. Abdel-Kader* | ||||
| Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, Egypt | ||||
| Abstract | ||||
| Hospital utilization review is considering one of the prominent cost containment programs in use in different countries. As hospital beds form an important health care resource, promising approaches to efficiency are directed towards avoiding inappropriate utilization of hospital beds. The present study was conducted to estimate the rate of inappropriate hospital admissions and days of care, to identify the variables associated with inappropriateness as well as to identify the reasons for inappropriateness. The study was conducted at one general hospital, affiliated to Health Insurance Organization [HIO] in Alexandria. Study population included patients admitted to internal medicine section during a period of one month. The population size accounted to 318 patients. Appropriateness Evaluation Protocol [AEP] was used to assess medical necessity for hospitalization at admission and on each subsequent day through retrospective review of medical records of patients admitted to internal medicine wards. The results revealed that inappropriate admissions to internal medicine section was very low [9.7%], in comparison to surgical section in previous studies, inappropriate admissions were higher among youngest and oldest age groups, patients with one or two diagnoses, and short stay cases. Care that could be done on an outpatient basis was the predominant reason for inappropriate admissions, being responsible for [83.0%] of reasons. A considerable percentage of cases [40.3%] had inappropriate days of care, and the inappropriate days amounted to 20 % of reviewed days, with an average of 2.7 inappropriate days/case. The commonest reason for inappropriate days was delay in discharge [35.7%] followed by delay in performing the work-up or treatment [35.1%]. It was mostly due to unavailability of plan for diagnostic procedure or treatment [16.8%] and problem in scheduling diagnostic procedure [12.0%] and delay in carrying out consultation [5.2%]. Univariate analysis of factors associated with inappropriate days of care revealed length of stay as the only variable that significantly affects inappropriate days of care. Inappropriateness was highest among cases stayed 15 days and more [64.3%]. | ||||
| Keywords | ||||
| Appropriateness; Hospital Utilization; Medical Admissions; Days of Care | ||||
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