Abstract
BackgroundInappropriate admissions cause excessive utilization of health services compared with outpatient services. However, it is still unclear whether inappropriate admissions cause excessive use of health services compared with appropriate admissions. This study aims to clarify the differences in the hospitalization performances between appropriately admitted inpatients and inappropriately admitted inpatients.MethodsA total of 2575 medical records were obtained after cluster sampling in three counties. Admission appropriateness was assessed by appropriateness evaluation protocol (AEP). The propensity score matching (PSM) was computed to match patients in treatment and control group with similar characteristics, and to examine the differences in the utilization of hospitalization services between the two groups. The samples were matched in two major steps in this study. In the first step, total samples were matched to examine the differences in the utilization of hospital services between the two groups using 15 individual covariates. In the second step, PSM was computed to analyze the differences between the two groups in different disease systems using 14 individual covariates.ResultsFor the whole sample, the inappropriate group has lower expenditure of hospitalization (EOH) (difference = − 0.12, p = 0.003) and shorter length of stay (LOS) (difference = − 0.73, p = 0.016) than the appropriate group. For number of clinical inspection (NCI), it has no statistically significant difference (difference = − 0.39, p = 0.082) between the two groups. Among different disease systems, no significant differences were observed between the two groups among EOH, LOS and NCI, except that the EOH was lower in the inappropriate group than that in the appropriate group for surgical disease (difference = − 0.169, p = 0.043).ConclusionInappropriate admissions have generated excessive health service utilization compared with appropriate admissions, especially for internal diseases. The departments in charge of medical services and hospital managers should pay high attention to the health service utilization of the inappropriately admitted inpatients. Relevant medical policies should be designed or optimized to increase the appropriateness in health care service delivery and precision in clinical pathway management.
Highlights
Inappropriate admissions cause excessive utilization of health services compared with outpatient services
Inappropriate admission refers to a condition that the utilization of hospitalization services is not conducted on the basis of clinical needs [2], and physicians act as patients’ agents and can influence the choice of patients to use hospitalization services compared to outpatient services
Admission appropriateness can be assessed by appropriateness evaluation protocol (AEP), which is an objective, effective and reliable tool used to evaluate the appropriateness of the admissions on the basis of inpatient’s medical records [3,4,5,6]
Summary
Inappropriate admissions cause excessive utilization of health services compared with outpatient services. It is still unclear whether inappropriate admissions cause excessive use of health services compared with appropriate admissions. Excessive use of health services leads to waste of health resources and unreasonable increase in medical costs. It is an issue of widespread concern across the globe. Inappropriate admission refers to a condition that the utilization of hospitalization services is not conducted on the basis of clinical needs [2], and physicians act as patients’ agents and can influence the choice of patients to use hospitalization services compared to outpatient services. AEP criteria can be divided into two parts: medical service intensity and disease severity
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