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

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.

Performance and Sociodemographic Determinants of Excess Outpatient Demand of Rural Residents in China: A Cross-Sectional Study

“…China suffers from severe excess healthcare demand, such as inappropriate admission [8][9][10][11], but studies on EOD are few. In terms of system setup, the construction of China's rural three-level healthcare delivery system is split with the development of marketization.…”

“…The inappropriate medical utilization is exacerbated; the rate of inappropriate admission in five county hospitals out of 2230 residents in central China was 15.2% in 2013 [10]. Congestion in high-level hospitals and the weakening or bankruptcy of primary hospitals contribute to the prominence of the contradiction between supply and demand [9]. EOD not only undermines primary care functions, but also crowds out resources for patients in need of high-level care.…”

“…Current studies on excess healthcare demand focus on inpatient research and include inappropriate admissions [9,20,21], inappropriate inpatient services [11,22] and lack the outpatient perspective. EOD in most Western countries, where the general practitioner and guiding mechanism are mostly perfect, hardly exists.…”

Prevalence and associated factors of inappropriate hospital admissions and days of children in a secondary hospital in Shanghai, China

“…Admissions through the emergency sector were identified to be associated with a higher risk of inappropriate admission. This result is unanticipated because, in most of the extant literature, concerning evaluations of hospital use by either adults or children, greater levels of inappropriateness were observed in admissions via outpatient sectors [ 11 , 19 , 26 ]. Potential explanations for this phenomenon include misuse of emergency resources by parents and poor communication between internal sectors in this hospital [ 26 ].…”

Unnecessary ultrasonography as supplier‐induced demand in diagnosis of primary breast cancer in Iran: A cross‐sectional study

“…13 The identification of this issue can be achieved through assessing the utilisation of data covering the healthcare service patterns in a population of patients with the aid of data registration systems and medical records. This requires the presence of precise definitions of 'necessary' and 'unnecessary' services that are based on evidence and clinical guidelines or that are defined by expert panels, 14,15 both of which have been used in this study.…”