Patient, provider and hospital characteristics associated with inappropriate hospitalization.

Siu, Albert L.; Manning, Willard G.; Benjamin, Bernadette

doi:10.2105/ajph.80.10.1253

Cited by 29 publications

(10 citation statements)

References 10 publications

(7 reference statements)

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“…Yet, this instrument has been shown to be valid and reliable in contexts close to ours, i.e. geriatric facilities [8,9], and elderly patients hospitalised in general medicine wards [10]. In contrast to admission appropriateness, our results regarding the estimates of appropriateness of the 14th/next-to-last hospital day parallel those of studies conducted in acute wards using the AEP (70-73% versus 80%) [5].…”

Section: Discussionsupporting

confidence: 67%

“…An admission or a day of care is deemed inappropriate if no criterion is met. This instrument was used as the best possible tool to approximate an objective evaluation in our care setting [8][9][10]. Other variables included socio-demographic characteristics, (instrumental) activities of daily living (ADL/IADL) [11,12], Mini Mental State Examination (MMSE) [13], and co-morbidities.…”

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Appropriateness of hospital use: comparison between elderly patients' point of view and a structured questionnaire

et al. 2007

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Appropriateness of hospital use: comparison between elderly patients' point of view and a structured questionnaire SIR-Appropriate use of hospitalisation is a key issue in terms of healthcare resources utilisation and individual needs. Surprisingly, there are only few studies assessing appropriateness of hospital stay in subacute settings. The demographic transition is associated with an increasing number of elderly people with multiple chronic conditions, and a growing need for subacute beds [1, 2]. In addition, the need to bolster rehabilitation is increasingly recognised for ageing patients for whom post-acute care is a pressing health policy issue [3, 4]. Optimal use of hospital beds also remains a challenge because of possible conflicts between medical needs and patients' preferences. Optimised use can contradict patients' views about 'best care' in terms of investigation, treatment, timing or location; and it can decrease their satisfaction as they do not always understand or accept the criteria used to determine the appropriateness of hospital use. Except for rare studies, research on the appropriateness of hospital use relied on professional opinion and/or application of review tools, and neglected patients' views [5, 6]. This study aimed at investigating patients' opinions about the appropriateness of their hospital stay. It also compared this 'subjective' appraisal to an 'objective' evaluation. Methods Setting The study was undertaken in the geriatric department of a university hospital. It was conducted in a 98-bed subacute ward where patients are either transferred from acute care wards (about 2/3) or directly admitted from the emergency room (about 1/3). The median length of stay (LOS) is 15 days and the mean is 21 days.

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Section: Discussionsupporting

confidence: 67%

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Appropriateness of hospital use: comparison between elderly patients' point of view and a structured questionnaire

et al. 2007

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“…Los resultados de este estudio muestran que la tasa de hospitalización en la población de 65 y más años se asocia con un estado de salud bajo, a la institucionalización, al sexo masculino, a determinadas patologías y a la utilización previa de servicios sanitarios. Adicionalmente, muestran una proporción de estancias inadecuadas en el límite alto de las encontradas en otros estudios realizados sobre población general o en ancianos 12,[19][20][21][22] que no se asocia al estado de salud, comorbilidad, ni uso previo de servicios sanitarios.…”

Section: Discussionunclassified

Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años

García¹,

Fuente²,

Peiró³

et al. 2001

Rev. Esp. Salud Publica

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Algunas características sociales, médicas o funcionales se asocian a mayor consumo de recursos sanitarios, sin que esto signifique un uso inapropiado de éstos. El objetivo de este trabajo es conocer la influencia del estado de salud y otros factores sobre las estancias hospitalarias y las estancias inapropiadas en la población mayor de 64 años. Método: Una cohorte representativa de la población mayor de 64 años del Partido Judicial de Toledo (n=3.214) en la que se había valorado el estado de salud, fue seguida durante 18 meses, identificando sus ingresos y estancias hospitalarias, cuya adecuación fue evaluada con el Appropiateness Evaluation Protocol. Se analizaron las asociaciones entre las características socio-demográficas, de estado de salud y morbilidad de la cohorte con las tasas de frecuentación y hospitalización y con la proporción de estancias e ingresos inadecuados. Resultados: Durante los 18 meses de seguimiento fueron hospitalizados 410 individuos (12,8%), que generaron 546 ingresos (tasa de frecuentación=17,0 ingresos/100 habitantes) y 7.015 días de estancia (tasa de hospitalización = 218,3 estancias/100 habitantes). El 18,9% de los ingresos y el 49,9% de las estancias fueron evaluadas como inadecuados. La hospitalización se asoció al peor estado de salud, institucionalización, género masculino, determinadas patologías y a la utilización previa de servicios sanitarios. No se hallaron asociaciones entre características de los pacientes y proporción de estancias inadecuadas. El 97,5% de las estancias innecesarias fue atribuido a problemas de programación hospitalaria y estilo de practica de los médicos. Conclusiones: Los factores socio-demográficos, de morbilidad, estado de salud y utilización previa de servicios se muestran como buenos predictores de hospitalización en las personas mayores, pero no se relacionan con el uso inadecuado de la hospitalización.

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“…The extent to which medical errors, in general, and medication errors, in particular, occur during care transitions is only recently becoming understood (Coleman 2003;Institute of Medicine 2001;Coleman et al 2002;Forster et al 2003;Halm et al 2003;Boockvar et al 2003;Moore et al 2003;Beers, Sliwkowski, and Brooks 1992;Meredith et al 2002;Cook, Render, and Woods 2000;Delgado-Rodriguez et al 2001;Mitchell, Swift, and Gilbert 1999). Although researchers have examined single care transitions (e.g., returning to the hospital after being discharged or transferring from a nursing home to a hospital), to date there has been a paucity of studies that have explored entire episodes of care--that is, the multiple transitions that these patients often experience (Ashton et al 1995;Weissman et al 1999;Barker et al 1994;Oddone et al 1996;Jones et al 1997;Lewis, Cretin, and Kane 1985;Waite et al 1994;Siu, Manning, and Benjamin 1990;Densen 1991).…”

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Posthospital Care Transitions: Patterns, Complications, and Risk Identification

Coleman

Min²,

Chomiak³

et al. 2004

Health Services Research

365

289

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Posthospital care transitions are common among Medicare beneficiaries and patterns of care vary greatly. A significant number of beneficiaries experienced complicated care transitions-a finding that has important implications for both patient safety and cost-containment efforts. Patients at risk for complicated care patterns can be identified using data available at the time of hospital discharge.

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Patient, provider and hospital characteristics associated with inappropriate hospitalization.

Cited by 29 publications

References 10 publications

Appropriateness of hospital use: comparison between elderly patients' point of view and a structured questionnaire

Appropriateness of hospital use: comparison between elderly patients' point of view and a structured questionnaire

Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años

Posthospital Care Transitions: Patterns, Complications, and Risk Identification

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