Variation in hospital use and avoidable patient morbidity

Increasing appropriateness of hospital admissions in the Emilia-Romagna region of Italy

Objectives:

The Emilia-Romagna region of Italy has reduced the number of available hospital beds and introduced financial incentives to curb hospital use. The goal of this study was to assess the impact of these policies on changes over time in the number of acute hospital admissions classified in diagnosis related groups (DRGs) that could be treated safely and effectively in alternative, less costly settings.

Methods:

The assessment of the appropriate site of care was based on analysis of hospital discharge data for all hospitals for the selected diagnosis related groups in the Emilia-Romagna region for 2001 to 2005. The necessity for acute hospital admission was based on the severity of a patient's principal diagnosis, co-morbid diseases and, for surgical admissions, procedure performed.

Results:

From 2001 to 2005, potentially inappropriate medical admissions of more than one day decreased from 20,076 to 11,580, a 42% decrease. Inappropriate admissions decreased in both public and private hospitals but there remained a higher rate of inappropriate admissions to private hospitals. Potentially inappropriate medical admissions accounted for 128,319 bed-days in 2001 and 68,968 bed-days in 2005, a reduction of 59,351 bed-days. Potentially inappropriate surgical admissions decreased from 7383 in 2001 to 4349 in 2005, a 41% decrease. Bed-days consumed by inappropriate surgical admissions decreased from 23,181 in 2001 to 13,660 in 2005.

Conclusions:

The Emilia-Romagna region has succeeded in reducing the use of acute hospital beds for patients in selected diagnosis related groups. However, there are still substantial numbers of admissions that could potentially be treated in less costly settings.

Características de la hospitalización evitable en España

BACKGROUND AND OBJECTIVE

Hospitalizations that could have been prevented with a timely and effective ambulatory care are known as avoidable hospitalizations (AH). The measure of AH is an indicator of the quality of primary health care centers. The objective of this study was to determine the factors that influence the level of AH at the Spanish public hospitals.

MATERIAL AND METHOD

We identified the characteristics of hospitalised patient as AH. We studied the total hospitalizations in public hospitals of Spain in 2000 related to AH.

RESULTS

AH admissions were the 15.8% of total in Spanish hospitals and the 16.6% of hospital stays. Patients' mean age was high, 54 years, males (age-adjusted OR = 1.54) with a large length of stay and presurgery stay, higher comorbidity (0.63 [0.8]), public financing, and admission was basically emergency-caused and in high complexity hospitals. There is a direct relationship between frequency of AH and hospital complexity.

CONCLUSIONS

The control of AH is very important because its repercussion on the total hospitalary case-mix. We observe an inducing effect of the hospital offer because the hospital capacity increase the number of AH admissions.