Rate Of Inappropriate Use Research Articles

The Appropriateness of Use of Coronary Angiography in New York State

To determine the appropriateness of use of coronary angiography in New York State. Retrospective randomized medical record review. Fifteen randomly selected hospitals in New York State that provide coronary angiography. Random sample of 1335 patients undergoing coronary angiography in New York State in 1990. Percentage of patients who underwent coronary angiography for appropriate, uncertain, or inappropriate indications. Approximately 76% of coronary angiographies were rated appropriate; 20%, uncertain; and 4%, inappropriate. Inappropriate use did not vary significantly between the elderly (ie, patients aged 65 years and older) and nonelderly, 4.7% and 3.9%, respectively. Although the rate of inappropriate use varied from 0% to 9% among hospitals, the difference was not significant. Rates of appropriateness did not vary by hospital location (upstate vs downstate), volume (fewer than 750 procedures annually or at least 750 procedures annually), teaching status, or whether revascularization was available at the hospital where angiography was performed. Although coronary angiography was used for few inappropriate indications in New York State, many procedures were performed for uncertain indications in which the benefit and risk were approximately equal or unknown.

Use of Albumin in a University Hospital: The Value of Targeted Physician Intervention

Results of a preliminary study of albumin use at the University of Michigan Hospital were shared with one surgical service (thoracic surgery) that had a documented high rate of inappropriate use. To determine the effectiveness of this targeted educational intervention in reducing inappropriate use and associated drug costs, albumin prescribing for all adult inpatients at University Hospital over a 30-day period was assessed in a retrospective review. Eighty-six patients used a total of 843 units, a ten percent reduction in total albumin use. Albumin administration to thoracic surgery patients decreased by 38 percent. The 35 percent reduction in inappropriate albumin use by this service (Fisher's exact test, p less than 0.001) was associated with an estimated annual cost savings of +83,500. Inappropriate albumin use by other medical services generally increased over previously measured levels. This study demonstrated the effectiveness of targeted educational interventions in reducing inappropriate albumin use and thereby controlling rising healthcare costs.

Medically inappropriate hospital use in a pediatric population.

To assess the extent of inappropriate hospital use in pediatric inpatients, I modified the Appropriateness Evaluation Protocol (AEP)--developed to assess inappropriate hospital use in adults--to apply to children and used it to evaluate pediatric inpatients retrospectively for every 10th day, from July 1982 to July 1983, at the University of Wisconsin Hospital. Of 1098 patient-days evaluated, 21.4 percent were judged to represent inappropriate hospital use on the basis of the protocol's criteria. The rate of inappropriate use varied according to admitting specialty, ranging from 7 of 70 days (10 percent) for pulmonary medicine to 43 of 61 days (70 percent) for neurology (P less than 0.005). There was a tendency toward lower rates of inappropriate use in uninsured patients (6 of 44 days [14 percent] vs. 226 of 1038 days [22 percent] in patients with Medicaid or private insurance, P = 0.13), and rates were lower in younger children (74 of 432 days [17 percent] in children less than or equal to 5 years of age vs. 162 of 656 days [25 percent] in children greater than 5 years of age, P less than 0.005). There was no variation according to sex, day of the week, or month. Contrary to expectations, inappropriate use decreased with increased lengths of stay (for stays of 1 day, 8 of 13 days were inappropriate [61 percent]; for stays of 2 to 6 days, 118 of 410 days were inappropriate [29 percent]; for 7 to 13 days, 58 of 291 [20 percent]; and for greater than or equal to 14 days, 51 of 362 [14 percent], P less than 0.001). I conclude that there is a substantial rate of inappropriate hospital use in pediatrics and that such use is more likely during short admissions than during long ones. Cost-containment efforts directed at limiting the length of hospitalization may therefore not reduce inappropriate hospital use in this population.

Inappropriate use and unmet need in paramedic and nonparamedic ambulance systems

A survey of emergency department visits was conducted over a 56-week period between November 1980 and November 1981. Inappropriate ambulance use and unmet ambulance need were compared between two cities (one large and one small) with paramedic ambulance services and two cities (one large and one small) with nonparamedic ambulance services. A total of 6,405 visits was evaluated, resulting in overall rates of inappropriate use and unmet need of 42% and 58%, respectively. When paramedic ambulance services were compared to nonparamedic services, the results indicated less inappropriate use in cities with paramedic services (34% vs 49%, P less than .001) as well as less unmet need in cities with paramedic services (48% vs 67%, P less than .001). These results remain consistent within most sample subgroups based on age, sex, time of arrival at ED, and disposition, except that no differences were found for small cities or for patients 50 years and older. The results indicate that paramedic ambulance systems are beneficial to the general population of emergency department users.