Assessment of appropriateness of hospitalisations in Ukraine: analytical framework, method and findings

Abstract

ObjectivesThis article reviews the applicability of a customised version of the Appropriateness Evaluation Protocol (AEP) to evaluate the magnitude of inappropriate hospitalisations in two regions of Ukraine.Data and methodsThe original AEP was modified to develop a customised tool, which included criteria for the appropriateness of hospitalisation and duration of inpatient stay. The customisation of the tool followed the Delphi procedure. We randomly selected 381 medical records to test the feasibility and reliability of the method and 800 medical records to evaluate the scope of inappropriate hospitalisations. We used descriptive and analytical statistics, receiver operating characteristic curve analysis and Cohen's kappa to check the consistency between the findings of primary reviewers and experts.ResultWe observed high levels of agreement in conclusions of primary reviewers (reference standard) and experts during testing of the reliability and validity of the method. The external validity check showed that the use of the tool by different experts provided high accuracy: 95.1 sensitivity, 76.6 specificity and area under ROC-curve (AUC)=0.948 (р<0.001) for analysis of the appropriateness of admissions; 95.3 sensitivity, 84.7 specificity and AUC=0.900 (р=0.001) for the duration of hospitalisations. Cohen's kappa coefficient (κ) indicated agreement in expert evaluations of 0.915 (95% СІ 0.799 to 1.000) and 0.812 (95% СІ 0.749 to 0.875), respectively.We found that over one-third of admissions (38.1%; 95% СІ 33.9 to 43.5) and over half of total bed-days were unnecessary (57.4%; 95% СІ 56.4 to 58.5). The highest levels of stay were observed in hospitals’ general medicine departments (64.6%; 95% СІ 63.0 to 66.3)compared with other departments included in the analysis.ConclusionThe proposed method is robust in assessing the appropriateness of hospitalisations and duration of inpatient stays. The quantified levels of unnecessary hospital care indicate the need for improving efficiency and quality of care and optimising the excessive hospital capacities in Ukraine.

Estimates of potentially preventable hospitalizations for ambulatory care sensitive conditions in Ukraine

“…The study was conducted using the WHO guidance on ACSCs for the European Region [9], which was adapted to the national context. It comprised four phases to: (1) define preliminary list of ACSCs using literature review; (2) analyze hospitalization rates of Ukrainian adult population according to the preliminary list of ACSCs; (3) assess relevance of specific ACSCs for Ukraine adults; and (4) evaluate potentially preventable hospitalizations (PPH) or the rate of ambulatory care sensitive hospitalizations (ACSH) according to the comprehensive list of the ACSCs.…”

“…During adaptation of the comprehensive list of ACSCs recommended by WHO [9] for Ukraine, we made few adjustments: we excluded dental conditions as hospitalizations for such cases is extremely rare, and noninfectious gastroenteritis and colitis as statistical data does not register such conditions. We did not include any additional ACSC to the WHO comprehensive list.…”

“…In settings with limited resources available for financing health care, the concept of ambulatory care sensitive conditions, or ACSCs becomes important. ACSCs are health conditions for which hospitalizations can be avoided by timely and effective care in ambulatory settings, specifically in primary health care [9].…”

“…The base list of ACSCs, developed by J. Billings et al [12] and categorized by M. Bardsley et al [11] to include three groups (acute, chronic, and vaccinepreventable conditions), has been continuously refined [15]. At the present stage of applying the ACSC concept, each country that studies this field using WHO guidance [9], develops a country-specific list of ACSCs, which usually includes diabetes, hypertension, heart failure, angina, kidney and urinary tract infections, chronic obstructive pulmonary disease (COPD), tuberculosis, and influenza [4][5][6][7][8].…”

Оцінка Важливості Проблеми Захворювань, Що Піддаються Амбулаторному Лікуванню В Україні

“…Незважаючи на зацікавленість та активність у вимірюванні і звітності щодо ЗПАЛ, зберігаються відмінності у визначеннях та підходах до їх вимірювання у різних країнах. Попри інтерес до даного питання у Європейському регіоні ВООЗ та зацікавленості України у проведенні досліджень щодо зменшення обсягів необґрунтованих госпіталізацій [3,18], нами не було виявлено проведених досліджень щодо ЗПАЛ у нашій країні, що і обумовило актуальність проведеного дослідження.…”