Halfon P, Eggli Y
The Planning and Evaluation Office, Centre Hospitalier et Universitaire Vaudois Lausanne, Switzerland.
Int J Qual Health Care. 2001 Aug;13(4):289-99. doi: 10.1093/intqhc/13.4.289.
The systematic use of regular hospital utilization reviews has proved costly, particularly in countries with short average lengths of stay. This study examines the performance of three tests based on routinely collected data when screening inappropriate hospital days.
The Appropriateness Evaluation Protocol was used to set the gold standard. The first screening test was simply based on the comparison of an observed length of stay with a target value; the second test additionally made allowances for surgical and intensive care procedures while the third added the amount of required nursing workload to these data.
The neurology and general surgery departments of a Swiss university hospital.
Every day of care for all inpatients stays was reviewed to assess the appropriateness of hospital use and submitted to the screening algorithm (9,000 hospital days).
Receiver-operating characteristics curves were compared to optimize the performance of the screening tests. The best test was applied to all units of the hospital and rates of inappropriate days were computed using a Bayesian approach.
The first and the second tests have a sensitivity of 66-80% and a specificity of 66-67%. Nursing workload data yield no significant improvement of the screening test. An unbiased estimate of the rate of inappropriate days may be computed.
The present study provides some evidence that a screening approach is useful, feasible and efficient for detecting inappropriate hospital days.
事实证明，系统地开展定期医院利用情况审查成本高昂，在平均住院时间较短的国家尤其如此。本研究考察了在筛查不适当住院日时，基于常规收集的数据进行的三项测试的性能。
采用适当性评估方案来设定金标准。第一项筛查测试仅基于观察到的住院时间与目标值的比较；第二项测试还考虑了外科手术和重症监护程序，而第三项测试则在这些数据基础上增加了所需护理工作量。
瑞士一家大学医院的神经科和普通外科。
对所有住院患者的每一天护理进行审查，以评估医院使用的适当性，并将其提交给筛查算法（9000个住院日）。
比较接受者操作特征曲线，以优化筛查测试的性能。将最佳测试应用于医院的所有科室，并使用贝叶斯方法计算不适当天数的发生率。
第一项和第二项测试的灵敏度为66 - 80%，特异度为66 - 67%。护理工作量数据并未显著改善筛查测试。可以计算出不适当天数发生率的无偏估计值。
本研究提供了一些证据，表明筛查方法对于检测不适当住院日是有用的、可行的且有效的。
