Appropriateness of hospital use - Report from an Italian study

The objective was to assess the extent of inappropriate hospital admission and stay in an adult patient population and identify potential correlates of such inappropriateness. Design: a cross-sectional survey on a sample of 1,082 in-patients using a modified version of the appropriateness evaluation protocol (AEP). Setting: adult acute departments in a 950 bed teaching hospital in the greater Milan area. The patient sample consisted of patients cared for at 1 of the participating departments on any of 3 index days between October 1989 and June 1990. The results show that overall 27% of the admissions and 40% of the hospital days were inappropriate. The rate of inappropriate admissions was higher for patients admitted during week days and was also significantly associated with the admitting ward and the age of the patient. Inappropriate hospital-day stays were related to the type of ward and to the location during the stay, with those sampled in the later part of their stay having the highest rate of inappropriateness. Most of the hospital days rated as not appropriate did not require any further stay (75%). Conclusions: a substantial proportion of hospital use was found to be medically unnecessary and, for the most part, due to hospital functioning or the behaviour of the doctors. Some properties of the AEP (high inter-rater reliability, predictivity of expected associations) were also confirmed. The basic features of this revised version of the AEP make it a good candidate for becoming of great importance in monitoring the effect of the changes the Italian National Health Service is currently undergoing.