An assessment of inappropriate hospital bed utilization by elderly patients in southern Italy

Bianco, Aida; Pileggi, Claudia; Rizza, Paolo; Greco, Maria Antonietta; Angelillo, Italo Francesco

doi:10.1007/bf03324656

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…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. The results of the present study are in agreement with the previous reports on inappropriate hospital admission of women or when no diagnostic tests are performed [9,18]. However, the rather large confidence intervals suggest that these effects have to be interpreted with caution.…”

Section: Discussionsupporting

confidence: 94%

“…This, however, is an unlikely explanation, as much lower rates of inappropriate admissions to medical wards have been reported in similarly aged populations in the past with frequencies ranging from 1.1 to 9.8% [17,18,20,21]. Therefore, it can be concluded that the prevalence rate of inappropriate hospital admissions observed in our study is still too high, and intervention may be necessary to reduce such hospital admissions.…”

Section: Discussioncontrasting

confidence: 73%

“…More recently, this rate of inappropriate hospital admission has decreased to 9.8%, with inappropriate admissions to medical wards being just 7.2% [18]. Inappropriate hospital use is much higher in the group of 85 years of age or older than in the 64-75 age group in a single study (53.3 vs. 46.1%, respectively) [19].…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 94%

Section: Discussioncontrasting

confidence: 73%

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

et al. 2011

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“…Furthermore, in a study conducted in Australian rehabilitation facilities using a utilization review method, Poulos et al reported 52% of hospital days as inappropriate [7]. Nevertheless, the percentage of inappropriate days of stay is lower than those obtained from our past experiences in evaluating the appropriateness in acute-care hospitals by using the Italian version of the AEP (PRUO), which showed a prevalence of inappropriate days of stay ranging from 39.5% in a population of elderly patients to 75.5% in a population of patients accessing the hospital through the Emergency Department [9], [11], [12].…”

Section: Discussionmentioning

confidence: 80%

“…In the past, well-designed research has investigated appropriateness of services utilization in various settings, such as adults acute hospital care [8], [9], pediatric [10] and elderly care [11], and in emergency units [12], due to the availability of a widely used and validated tool for the assessment of inappropriate acute hospital use, the Appropriateness Evaluation Protocol (AEP) [13], and its Italian version (PRUO).…”

Section: Introductionmentioning

confidence: 99%

Validity and Reliability of a Tool for Determining Appropriateness of Days of Stay: An Observational Study in the Orthopedic Intensive Rehabilitation Facilities in Italy

et al. 2012

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ObjectivesTo test the validity and reliability of a tool specifically developed for the evaluation of appropriateness in rehabilitation facilities and to assess the prevalence of appropriateness of the days of stay.MethodsThe tool underwent a process of cross-cultural translation, content validity, and test-retest validity. Two hospital-based rehabilitation wards providing intensive rehabilitation care located in the Region of Calabria, Southern Italy, were randomly selected. A review of medical records on a random sample of patients aged 18 or more was performed.ResultsThe process of validation resulted in modifying some of the criteria used for the evaluation of appropriateness. Test-retest reliability showed that the agreement and the k statistic for the assessment of the appropriateness of days of stay were 93.4% and 0.82, respectively. A total of 371 patient days was reviewed, and 22.9% of the days of stay in the sample were judged to be inappropriate. The most frequently selected appropriateness criterion was the evaluation of patients by rehabilitation professionals for at least 3 hours on the index day (40.8%); moreover, the most frequent primary reason accounting for the inappropriate days of stay was social and/or family environment issues (34.1%).ConclusionsThe findings showed that the tool used is reliable and have adequate validity to measure the extent of appropriateness of days of stay in rehabilitation facilities and that the prevalence of inappropriateness is contained in the investigated settings. Further research is needed to expand appropriateness evaluation to other rehabilitation settings, and to investigate more thoroughly internal and external causes of inappropriate use of rehabilitation services.

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The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs

2015

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An assessment of inappropriate hospital bed utilization by elderly patients in southern Italy

Abstract: Interventions are needed in order to increase the quality and efficiency of hospital care, by rectifying the attitudes and behaviors of Italian physicians.

Cited by 11 publications

References 14 publications

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

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

Validity and Reliability of a Tool for Determining Appropriateness of Days of Stay: An Observational Study in the Orthopedic Intensive Rehabilitation Facilities in Italy

The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs

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