Prs45 Comparison Study of Current Global Initiative for Chronic Obstructive Lung Disease (Gold) Recommendations With Copd Exacerbation Treatments in Mississippi Medicaid

Abstract

Inappropriate admissions of respiratory diseases is high and difficult to regulate. The aim of this study was to identify the determinants of inappropriate admission to hospitalized patients with respiratory diseases in rural areas. Methods: In this study, 1141 inpatient records of respiratory diseases from 4 counties were collected by a stratified random sampling method in central and western China. An adjusted Appropriateness Evaluation Protocol (AEP) was used to evaluate the admission records of inpatients suffering from respiratory diseases. Determinants related to the inappropriate admissions to county hospital for respiratory diseases were analyzed by using a binary logistic regression. Results: The top five positive indicators of respiratory disease assessment were B14 acute hematopathy, severe medium-sized leukopaenia, thrombocytopaenia, leukocytosis, erythrocytosis, thrombocytosis or haemolysis-resulted symptoms, A2 treatment with varying dosages or drugs on a regular basis under direct medical supervision), A3 calculation of intake and output volume, B19 lung infection above 50% or leafy lesions according to X-ray examination and A8 stopping (at least once every 8 h) or continuing oxygen inhalation. The inappropriate admission rate of respiratory diseases was 33.7 %, among which Dingyuan County in Anhui Province was the highest (42.5%), and Huining County in Gansu Province was the lowest (27.6%). Inappropriate admissions were more likely in internal medicine (36.9%) and surgery (37.0%) department, mainly found for patients aged 40-59 years (41%) and who admitted in spring (37.7%) and the length of stay more than 14 days(48.6%). The logistic regression analysis showed that county, gender, age, season, admitted severity, health status and disease were determinants of inappropriate admission to patients with respiratory diseases in county hospitals. Conclusions: Policymakers must act to reduce the high prevalence of inappropriate admissions for respiratory diseases in county hospitals in rural China, by strengthening chronic disease prevention and control and changing the motivating mechanism of these hospitals.