Moya-Ruiz Carles, Peiró Salvador, Meneu Ricard
Hospital Sant Boi, Barcelona, Spain.
Int J Qual Health Care. 2002 Aug;14(4):305-12. doi: 10.1093/intqhc/14.4.305.
To evaluate the effectiveness of feedback to medical staff in reducing inappropriate hospital days, particularly those attributable to conservative medical discharge policies.
Quasi-experimental pre-test/post-test with non-equivalent control group.
A publicly funded hospital in industrial belt in Barcelona (Spain), serving a predominantly urban population of 100,000.
Two non-equivalent groups: control group (surgery department) and intervention group (internal medicine department).
Meetings between hospital management and medical staff of the intervention group to inform clinicians of percentages and reasons for inappropriate stays in their departments.
Total inappropriate hospital days and percentage attributable to physicians, measured with the Appropriateness Evaluation Protocol before, during, and after intervention.
There were no relevant differences in the characteristics of the populations whose stays were reviewed during each of the periods. The total number of inappropriate stays and the percentage attributable to the doctor in the control group did not show any differences between the periods. In the intervention group, inappropriate stays attributable to the doctor decreased from 35.9% in the period to intervention to 27.7% during intervention (relative drop of 22.8%; P < 0.01), and rose to 32.7% after intervention. Differences in total inappropriate days were not significant.
Providing physicians with feedback about percentage of inappropriate hospital days produced a significant reduction in the number of inappropriate stays attributable to the doctor, although the impact on overall inappropriate stays is inconclusive.
评估向医务人员提供反馈对于减少不适当住院天数的有效性，尤其是那些归因于保守的医疗出院政策的天数。
采用非等效对照组的准实验性前测/后测。
西班牙巴塞罗那工业带的一家公立资助医院，主要服务于10万城市人口。
两个非等效组：对照组（外科）和干预组（内科）。
医院管理层与干预组医务人员举行会议，告知临床医生其科室不适当住院的百分比及原因。
干预前、干预期间和干预后，使用适宜性评估方案测量总的不适当住院天数以及归因于医生的百分比。
在各个时期接受住院审查的人群特征方面没有相关差异。对照组中不适当住院的总数以及归因于医生的百分比在各时期之间没有显示出任何差异。在干预组中，归因于医生的不适当住院从干预前时期的35.9%降至干预期间的27.7%（相对下降22.8%；P<0.01），干预后升至32.7%。总的不适当天数差异不显著。
向医生提供关于不适当住院天数百分比的反馈，使归因于医生的不适当住院次数显著减少，尽管对总体不适当住院的影响尚无定论。
