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Inappropriate admissions have contributed to the rapid increase in hospitalisations in rural China. This study characterised the degree and determinants of inappropriate admissions in county hospitals. We used expert consultation to develop an appropriateness evaluation protocol that included nine requirements for services and 21 indicators of disease severity. A total of 2230 medical records from 2014 were collected from five county hospitals by stratified cluster sampling and evaluated for appropriateness using the protocol in 2016. The determinants of inappropriate admissions were analysed by two-level logistic regression. The overall inappropriate admission rate was 15.2%. Patients aged <20 years (19.3%), patients in the paediatrics department (22.9%), patients with lower disease severity (22.3%), and patients without complications (17.0%) were more likely to have been inappropriately admitted than other groups. Age, treating department, disease severity, causes of hospitalisation, complications, and length of stay were determinants of inappropriate admission. Policymakers must act to reduce the high prevalence of inappropriate admissions in county hospitals in rural China, by guiding patients to seek primary care and changing the motivating mechanism of these hospitals.

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