Merom D, Shohat T, Harari G, Oren M, Green M S
Israel Center for Disease Control, Gertner Institute, Chaim Sheba, Tel-Hashomer, Israel.
Int J Qual Health Care. 1998 Apr;10(2):155-62. doi: 10.1093/intqhc/10.2.155.
The high costs of health care mandate a quality control system that ensures efficient utilization of hospitalization days.
To obtain a national estimate of the rate of inappropriate hospitalization days in medical wards and to identify the variables associated with inappropriateness.
A 1-day cross-national survey.
A sample of internal medicine wards in all public hospitals in Israel. SURVEY POPULATION: The survey population included all patients hospitalized in the ward for at least 24 hours on the survey day.
We used an adapted version of the appropriateness evaluation protocol (AEP) (Gertman and Restuccia). Reviewers were final year medical students trained to work with the AEP. Final classification of inappropriate days was done by one of the senior investigators.
Utilization of hospitalization days according to the AEP.
A total of 1003 hospitalization days in 33 medical wards in 24 hospitals was surveyed. Of this, 182 (18.1%) of the days were found to be inappropriate. In multiple logistic regression analysis, variables significantly associated with inappropriate days were government versus other hospital ownership (OR, 1.51; CI, 1.15-1.96), diagnosis on admission of acute cardiac event versus other diagnosis (OR, 0.46; CI, 0.27-0.77), and period (first, second or final third) of the stay (OR, 1.61; CI, 1.29-2.03). In 62.6% of the 'inappropriate days', continuation of hospitalization was justified (72% were patients awaiting tests or consultation). In 6.7% of the total days surveyed, no justification for continuation of hospitalization was found.
The percentage of inappropriate days found in this study is similar to the means found in studies that were conducted in other countries. Awaiting procedures and consultation is a major cause of inappropriate days and may be an important target for intervention.
医疗保健的高成本要求建立一个质量控制系统，以确保住院天数的有效利用。
获得全国内科病房不适当住院天数发生率的估计值，并确定与不适当性相关的变量。
为期1天的跨国调查。
以色列所有公立医院内科病房的样本。
调查人群包括在调查日在病房住院至少24小时的所有患者。
我们使用了适当性评估协议（AEP）（格特曼和雷斯图西亚）的改编版本。评审人员是接受过使用AEP培训的医学专业最后一年的学生。不适当天数的最终分类由一位资深调查员完成。
根据AEP对住院天数的利用情况。
对24家医院33个内科病房的1003个住院日进行了调查。其中，182天（18.1%）被发现是不适当的。在多因素逻辑回归分析中，与不适当天数显著相关的变量有政府所有与其他医院所有制（比值比[OR]，1.51；可信区间[CI]，1.15 - 1.96）、入院诊断为急性心脏事件与其他诊断（OR，0.46；CI，0.27 - 0.77）以及住院期间（第一、第二或最后三分之一时间段）（OR，1.61；CI，1.29 - 2.03）。在62.6%的“不适当天数”中，住院的延续是合理的（72%是等待检查或会诊的患者）。在调查的总天数中，6.7%没有发现住院延续的合理理由。
本研究中发现的不适当天数百分比与其他国家进行的研究中发现的平均值相似。等待检查和会诊是不适当天数的主要原因，可能是干预的一个重要目标。
