Department of Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.
Department of Community and Family Medicine, Social Determinants of Health Research Center, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran.
Value Health Reg Issues. 2020 May;21:105-112. doi: 10.1016/j.vhri.2019.07.011. Epub 2019 Nov 5.
Inappropriate admission and hospitalization are types of overuse that impose a financial burden on all health systems, especially in hospitals.
To analyze the evidence on the inappropriateness of admission and hospitalization in Iranian hospitals.
This study was conducted using PubMed, Embase, Scopus, and Web of Science, as well as Persian databases, including Magiran and Scientific Information Database up to May 2018. Two researchers extracted result of the included studies, independently. We used Cohen's κ statistic for measuring inter-rater agreement. The meta-analyses were conducted based on pooled effect estimates for the rate of admission and hospitalization using the DerSimonian-Laird random-effects model with 95% confidence intervals (CI).
Seventeen articles met the inclusion criteria. The inter-rater agreement was very good for abstracts and full-texts screening (κ 0.86 and 98, respectively). The overall inappropriate rate was 12.3% (95% CI, 8.4-17.5) and 11.9% (95% CI, 7.7-18.1) for admission and hospitalization, respectively. The inappropriate rate of admission was significantly higher before the Health Sector Evolution Plan (HSEP) than after HSEP (14.6%, 95% CI, 8.6-23.6 before HSEP and 10%, 95% CI, 5.5-17.3 after HSEP), and the inappropriate rate of hospitalization was significantly higher after HSEP than before HESP (9.5%, 95% CI, 5.2-16.7 before HSEP and 16.9%, 95% CI, 8.2-31.7 after HSEP).
Adoption standard measures of admission and hospitalization, treating patients in appropriate care centers, and establishing a referral system is essential to reduce the inappropriate admission and hospitalization in Iranian hospitals. Such interventions can lead to a reduction in personnel costs and workload and ultimately increase the productivity of the hospital.
不适当的入院和住院属于过度医疗的一种，会给所有医疗体系带来经济负担，尤其是医院。
分析伊朗医院入院和住院不适当的相关证据。
本研究检索了 PubMed、Embase、Scopus 和 Web of Science 以及 Persian 数据库（包括 Magiran 和 Scientific Information Database），检索时间截至 2018 年 5 月。两位研究者独立提取纳入研究的结果。我们使用 Cohen's κ 统计量来衡量评价者间的一致性。采用 DerSimonian-Laird 随机效应模型，使用 95%置信区间（CI）对纳入研究的入院和住院率进行汇总效应估计的荟萃分析。
17 篇文章符合纳入标准。摘要和全文筛选的评价者间一致性非常好（κ 值分别为 0.86 和 98）。总体不适当率分别为 12.3%（95% CI，8.4-17.5）和 11.9%（95% CI，7.7-18.1），分别为入院和住院。HSEP 实施前的入院不适当率显著高于 HSEP 实施后（HSEP 实施前为 14.6%，95% CI，8.6-23.6；HSEP 实施后为 10%，95% CI，5.5-17.3），HSEP 实施后的住院不适当率显著高于 HSEP 实施前（HSEP 实施前为 9.5%，95% CI，5.2-16.7；HSEP 实施后为 16.9%，95% CI，8.2-31.7）。
采用入院和住院标准措施、在合适的医疗机构治疗患者、建立转诊系统，对减少伊朗医院的不适当入院和住院至关重要。此类干预措施可以降低人员成本和工作量，最终提高医院的生产力。
