Design and Development of a Utilization Review Program in Portugal

Abstract

This paper describes the work that has been under way in the Portuguese government hospital sector, with respect to the use of an adapted version of the Appropriateness Evaluation Protocol (AEP). Modifications to the original system were determined through a series of experiments at pilot hospitals and reliability and user profile studies were subsequently conducted using the modified criteria. Results were of great value in terms of the identification and quantification of problems. On average, approximately one in every four non-obstetric admissions and one in every 2 days of stay were deemed inappropriate and 75% of all inappropriate days were related to patients who were ready for discharge. It is expected that the use of the modified AEP will be extended and enhanced over the next few years. In this regard, advantage has already been taken of the implementation of an output-based funding system, combining retrospective statistical analysis of the hospitals' inpatient databases with targeted reviews of individual patients.

Introduction

“…This study reported a 12% rate of inappropriate hospitalization use, which falls within the 5% to 74% [18,[20][21][22][23][24][25][26] ranges reported in literature.…”

The hospital appropriateness evaluation protocol in elderly patients: a technique to evaluate admission and hospital stay

“…effective biomedical technological resources have been utilized in situations in which these resources are not indicated from the strictly medical point of view (7). In the United States, it has been described that there is an inappropriate hospitalization use in elderly population of between 18% and 50% (8), and of between 10% and 74% in the European Union (EU) (8–13).…”

The cost of inappropriate admissions: a study of health benefits and resource utilization in a department of internal medicine

“…An ‘inappropriate hospital admission’ can be defined as an admission that does not result in any significant benefit for the patient, or which results in benefit which could have been obtained at a lower care level. Studies from different countries have almost invariably found high rates of such admissions, with most reported percentages in the range of 10–25 [1–8]. One reason for the interest in inappropriate admissions has been the belief that they represent a potential for proportional cost reductions.…”