Abstract
BackgroundInappropriate use of acute hospital beds is a major topic in health politics. We present here a new approach to measure unnecessary hospitalizations in Medicine and Pediatrics.MethodsThe necessity of a hospital admission was determined using explicit criteria related to the recorded diagnoses. Two indicators (i.e. “unjustified” and “sometimes justified” stays) were applied to more than 800,000 hospital stays and a random sample of 200 of them was analyzed by two clinicians, using routine data available in medical statistics. The validation of the indicators focused on their precision, validity and adjustment, as well as their usefulness (i.e. interest and risk of abuse).ResultsRates, adjusted for case mix (i.e. age of patient, admission planned or not), showed statistically significant differences among hospitals. Only 6.5% of false positives were observed for “unjustified stays” and 17% for “sometimes justified stays”. Respectively 7 and 12% of stays had an unknown status, due to a lack of sufficiently precise data. Considering true positives only, almost one third of medical and pediatric stays were classified as not strictly justified from a medical point of view in Switzerland. Among these stays, about one fifth could have probably been avoided without risk. To enable a larger ambulatory shift, recommendations were made to strengthen the ambulatory care, notably regarding post-emergency follow-up, cardiac and pulmonary functions’ monitoring, pain management, falls prevention, and specialized at-home services that should be offered.ConclusionWe recommend using “unjustified stays” and “sometimes justified stays” indicators to monitor inappropriate hospitalizations. The latter could help the planning of reinforced ambulatory care measures to pursue the ambulatory shift. Nonetheless, we clearly advise against the use of these two indicators for hospitals financing purposes.
Highlights
Inappropriate use of acute hospital beds is a major topic in health politics
The Ambulatory Care Sensitive Conditions (ACSC) indicator enables to monitor the first aspect by screening stays that might have been prevented had the patient had access to adequate primary care services [9, 10]
A quarter of unjustified stays had no severe diagnosis after investigation, but patients were admitted as a precaution
Summary
Inappropriate use of acute hospital beds is a major topic in health politics. We present here a new approach to measure unnecessary hospitalizations in Medicine and Pediatrics. Inappropriate use of acute hospital beds is a challenging issue that has several detrimental implications Does it increase the health care costs (in Switzerland, a group of experts recently highlighted the importance of the ambulatory shift, to reduce these costs [1]), but hospitalization in itself might be harmful [2, 3]. Eggli et al BMC Health Services Research (2022) 22:158 very easy to compute from routinely available hospital medical records It suffers several limitations, including lack of sensitivity and specificity [11], poor clinical relevance [12], and low proportion of hospitalization preventable [13], its main drawback being that high rates of ACSC might be associated to differences in admission hospital practices rather than to the quality of ambulatory care [14]
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