Inappropriate admissions of the cardiology and orthopedics departments of a tertiary hospital in Shanghai, China.

Wenwei Liu,Suwei Yuan,Jin Ma,Fengqin Wei,Jing Yang

doi:10.1371/journal.pone.0208146

Abstract

ObjectivesAdmission rates have increased in China, despite the fact that accessibility to primary care is improving. Hospital care could be cost-inefficient, and little is currently known about the appropriateness of admissions to tertiary hospitals in China. This study aims to measure the extent of inappropriate admissions in the cardiology and orthopedics departments of a tertiary hospital in Shanghai, to explore the factors associated with inappropriateness for each department, and to identify the causes of inappropriate admissions.MethodsThe records of inpatients discharged on randomly sampled two days each week during March 2013 to February 2014 from the two departments were extracted. Two reviewers were recruited to assess the records according to the Chinese version of the Appropriateness Evaluation Protocol (C-AEP). Demographic, socio-economic, and other admissions-related variables were collected. Logistic regression analysis was adopted to determine the associated factors of inappropriateness.Results35.0% (N = 120) of the 343 admissions and 38.7% (N = 179) of the 463 admissions of the cardiology and orthopedics departments were not justified by the C-AEP, respectively. Age (OR = 0.717), self-pay (OR = 3.752), admission via outpatient sector (OR = 5.332), and readmission (OR = 2.501) were identified as factors affecting the appropriateness of admissions in the cardiology department. Age (OR = 0.930), self-pay (OR = 2.597), admission during 12:00–17:59 (OR = 3.211), and admission via outpatient sector (OR = 7.060) were determined to be associated with appropriateness of admission in the orthopedics department. The main reason for inappropriateness was premature admission for both departments.ConclusionsThe magnitude of inappropriate admissions was considerable in the departments. To improve appropriateness, the results suggest that further interventions should be focused on both external and internal factors.

Highlights

Hospital care is normally much more expensive than other alternatives
The results suggest that further interventions should be focused on both external and internal factors
A total of 806 records were extracted from the electronic patient history system. 343 and 463 admissions of the cardiology department and the orthopedics department were reviewed, respectively. 28.4% and 54.6% of the patients were female, and the median age was 65 (IQR = 36) and 57 (IQR = 26), respectively. 97.6% (N = 330) in the cardiology department and 86.0% (N = 394) in the orthopedics department were married

Summary

Introduction

Hospital care is normally much more expensive than other alternatives. For example, in China, the average cost of an inpatient stay was 7442.3 CNY and 2482.7 CNY of hospital and a primary health provider in 2013, respectively [1]. Many appropriateness studies have been conducted to explore the prevalence, associated factors, and causes of inappropriateness in different countries and localities [4,5,6,7,8]. This kind of effort is lacking in China. Only three published studies have investigated the appropriateness of admissions in mainland China [9,10,11] These studies were either performed in a less intensive environment in township hospitals or adopted a less valid screening tool for less appropriate patient samples, e.g., patients under 16 years old [9,10,11]

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