Assessing the necessity of hospital stay by means of the Appropriateness Evaluation Protocol: how strong is the evidence to proceed?

Smeets, Patrick M. J. H; Verheggen, Frank W.S.M.; Pop, P.; Panis, Lambert J.G.G.; Carpay, Jan J

doi:10.1093/intqhc/12.6.483

Cited by 30 publications

(18 citation statements)

References 37 publications

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“…The results of the present analysis confirm a high rate of inappropriate hospital use in Bolzano, and should stimulate local health policy to reassess the regional system and enable targeted interventions. Even though validity and reliability of the AEP are considered by some as not yet being up to standard [23], regarding the results of the interventions thus far, its further use is encouraged [9,11]. Limitations of our study, other than its reliance on AEP, include the small sample size precluding stronger conclusions for some of the predefined subgroups, such as professional and marital status or distance from home to hospital.…”

Section: Discussionmentioning

confidence: 90%

Inappropriate hospital admission: interaction between patient age and co-morbidity

et al. 2011

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The aim of the study is to determine the prevalence of inappropriate admission, and to identify the factors that influence appropriateness of hospital admission. Data were prospectively collected from all 345 consecutive patients admitted during the period of 1 month for acute hospital care at a 110-bed division of internal medicine using socio-demographic and medical information. Statistical analyses included χ2 tests, t tests, and logistic regression analyses. According to the European version of the Appropriateness Evaluation Protocol of hospital admission, 28.1% of medical admissions for acute care in the Central Hospital of Bolzano, Italy, have been classified as inappropriate. Factors that reduced appropriateness included female gender, age and chronic illness that are significantly associated with appropriateness of medical admission, whereas time of day or day of week of the emergency department (ED) visit does not influence appropriateness. In multiple logistic regression analyses, age and co-morbidity are not independently related to appropriateness, however, when tested for interaction, inappropriateness is significantly more frequent at a young age in the absence of co-morbidities, and, numerically most relevant, in elderly patients presenting with co-morbidities. In this evaluation of a single centre North Italian hospital admission, co-morbidity turns out to be an important age-dependent determinant of appropriateness. Although in the young age group, co-morbidity increases the likelihood of being appropriately admitted, the presence of chronic illness in the elderly increases the risk of inappropriate hospital use.

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Section: Discussionmentioning

confidence: 90%

Inappropriate hospital admission: interaction between patient age and co-morbidity

et al. 2011

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“…In this perspective, the Appropriateness Evaluation Protocol (AEP) is one of the most valid tools [3][4][5][6][7][8][9]. The AEP assesses the relevance of an admission or of a hospitalisation day through explicit, predefined criteria, which are related to care but independent of the pathology [3].…”

Section: Introductionmentioning

confidence: 99%

“…The AEP assesses the relevance of an admission or of a hospitalisation day through explicit, predefined criteria, which are related to care but independent of the pathology [3]. It is an instrument applicable to all adult patients admitted in a medical, surgical or gynaecological service [4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Assessing the causes inducing lengthening of hospital stays by means of the Appropriateness Evaluation Protocol

Fontaine¹,

Jacques

Gillain³

et al. 2011

Health Policy

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“…Individualised care programmes for patients at high risk of hospitalisation have been effective at reducing health costs in countries including Sweden, Germany, America and the UK [1,8,18,32] and incorporating risk profiling tools into UK-based systems has proved unproblematic [18]. However, there are multiple systems in place (see Table 3); and contradictory findings about their effectiveness; [25,33-35] and some patients at high predicted risk of admission may not be amenable to preventative care [36]. …”

Section: Discussionmentioning

confidence: 99%

Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network

Woodhams

Lusignan

Mughal³

et al. 2012

BMC Health Serv Res

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BackgroundInternationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare.MethodWe set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops.ResultsWe identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR – Patients at risk of readmission and ACG – Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission.ConclusionsDespite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don’t change.

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Assessing the necessity of hospital stay by means of the Appropriateness Evaluation Protocol: how strong is the evidence to proceed?

Cited by 30 publications

References 37 publications

Inappropriate hospital admission: interaction between patient age and co-morbidity

Inappropriate hospital admission: interaction between patient age and co-morbidity

Assessing the causes inducing lengthening of hospital stays by means of the Appropriateness Evaluation Protocol

Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network

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