Navarro G, Prat-Marin A, Asenjo M, Menacho A, Trilla A, Salleras L
Department of Preventive Medicine and Technical Management, IDIBAPS, Hospital Clínic Medical School, University of Barcelona, Spain.
Eur J Epidemiol. 2001;17(7):679-84. doi: 10.1023/a:1015563618836.
To test the applicability of the appropriateness evaluation protocol (AEP) as a tool for reviewing hospital utilisation. To quantify and to compare the rate of inappropriate admissions and amount of in-hospital days, emphasising the main causes and factors in the hospital associated with inappropriateness during the studied periods of time.
Two retrospective studies were carried out, the first one in 1992, when 2048 clinical histories were analysed, and the second in 1996, with 1099 reviewed histories. The tool used for the evaluation of the level of hospital utilisation is the AEP.
The proportion of admissions considered to be inappropriate was 25% (95% CI: 20.8-24.5) in 1992, and 16% (95% CI: 13.8-18.2) in 1996. Premature admission was the most frequent cause of inappropriateness in both periods. The logistic regression model built for the dependent variable admission showed the following variables to be associated to inappropriateness: scheduled admission (OR: 15; 95% CI: 10.8-20.7) and (OR: 10; 95% CI: 6-16.5), weekend admission (OR: 2; 95% CI: 1.3-1.2) and (OR: 2; 95% CI: 1.2-2.3), for 1992 and 1996, respectively. The rate of inappropriate in-hospital stays in 1992 was 29% (95% CI: 28.3-29.6), and 13.5% (95% CI: 12.7-14.3) in 1996. Hospital organisational problems were the main cause of inappropriate in-hospital days in 1992, and diagnostic/ therapeutical tests that could be performed ambulatorily ranked first in 1996. The logistic regression model built for the dependent variable in-hospital days had the following independent variables associated to its inappropriateness: discharge on weekdays (OR: 1.4; 95% CI: 1.2-1.8) and (OR: 0.6; 95% CI: 0.5-0.8) and length of stay (OR: 2; 95% CI: 1.8-2.4) and (OR: 2.4; 95% CI: 2.3-2.5), for 1992 and 1996 respectively, among other variables.
Periodic checking of the utilisation levels with the application of methods such as the AEP will contribute towards adapting hospital management in the more competitive current setting.
测试适用性评估方案（AEP）作为审查医院利用情况工具的适用性。量化并比较不适当入院率和住院天数，强调研究期间医院中与不适当性相关的主要原因和因素。
进行了两项回顾性研究，第一项于1992年开展，分析了2048份临床病历，第二项于1996年进行，审查了1099份病历。用于评估医院利用水平的工具是AEP。
1992年被认为不适当的入院比例为25%（95%可信区间：20.8 - 24.5），1996年为16%（95%可信区间：13.8 - 18.2）。在两个时期，过早入院都是不适当性最常见的原因。为因变量入院构建的逻辑回归模型显示，以下变量与不适当性相关：计划性入院（1992年：比值比：15；95%可信区间：10.8 - 20.7；1996年：比值比：10；95%可信区间：6 - 16.5）、周末入院（1992年：比值比：2；95%可信区间：1.3 - 1.2；1996年：比值比：2；95%可信区间：1.2 - 2.3）。1992年不适当住院天数的比例为29%（95%可信区间：28.3 - 29.6），1996年为13.5%（95%可信区间：12.7 - 14.3）。1992年，医院组织问题是不适当住院天数的主要原因，1996年可门诊进行的诊断/治疗检查排在首位。为因变量住院天数构建的逻辑回归模型显示，以下自变量与其不适当性相关：工作日出院（1992年：比值比：1.4；95%可信区间：1.2 - 1.8；1996年：比值比：0.6；95%可信区间：0.5 - 0.8）、住院时间（1992年：比值比：2；95%可信区间：1.8 - 2.4；1996年：比值比：2.4；95%可信区间：2.3 - 2.5）等其他变量。
通过应用AEP等方法定期检查利用水平将有助于在当前竞争更激烈的环境中调整医院管理。
