Effect of inappropriate admissions on hospitalization performance in county hospitals: a cross-sectional study in rural China

Abstract

Background Inappropriate admissions cause excessive utilization of health services compared with outpatient services. However, it is still unclear whether inappropriate admissions cause excessive use of health services compared with appropriate admissions. This study aims to clarify the differences in the hospitalization performances between appropriately admitted inpatients and inappropriately admitted inpatients. Methods A total of 2575 medical records were obtained after cluster sampling in three counties. Admission appropriateness was assessed by appropriateness evaluation protocol (AEP). The propensity score matching (PSM) was computed to match patients in treatment and control group with similar characteristics, and to examine the differences in the utilization of hospitalization services between the two groups. The samples were matched in two major steps in this study. In the first step, total samples were matched to examine the differences in the utilization of hospital services between the two groups using 15 individual covariates. In the second step, PSM was computed to analyze the differences between the two groups in different disease systems using 14 individual covariates. Results For the whole sample, the inappropriate group has lower expenditure of hospitalization (EOH) (difference = − 0.12, p = 0.003) and shorter length of stay (LOS) (difference = − 0.73, p = 0.016) than the appropriate group. For number of clinical inspection (NCI), it has no statistically significant difference (difference = − 0.39, p = 0.082) between the two groups. Among different disease systems, no significant differences were observed between the two groups among EOH, LOS and NCI, except that the EOH was lower in the inappropriate group than that in the appropriate group for surgical disease (difference = − 0.169, p = 0.043). Conclusion Inappropriate admissions have generated excessive health service utilization compared with appropriate admissions, especially for internal diseases. The departments in charge of medical services and hospital managers should pay high attention to the health service utilization of the inappropriately admitted inpatients. Relevant medical policies should be designed or optimized to increase the appropriateness in health care service delivery and precision in clinical pathway management.

Does Health Insurance Lead to Improvement of Health Status Among Chinese Rural Adults? Evidence From the China Family Panel Studies

“…The average treatment effect on the treated (ATT), which reflects the level of change in health status variable after controlling for the covariates, 48 is calculated after matching as follows:…”

Performance and Sociodemographic Determinants of Excess Outpatient Demand of Rural Residents in China: A Cross-Sectional Study

“…Current studies on excess healthcare demand focus on inpatient research and include inappropriate admissions [ 9 , 20 , 21 ], inappropriate inpatient services [ 11 , 22 ] and lack the outpatient perspective. EOD in most Western countries, where the general practitioner and guiding mechanism are mostly perfect, hardly exists.…”

“…China suffers from severe excess healthcare demand, such as inappropriate admission [8][9][10][11], but studies on EOD are few. In terms of system setup, the construction of China's rural three-level healthcare delivery system is split with the development of marketization.…”

Advance care plans in UK care home residents: a service evaluation using a stepped wedge design

“…It is a matter for society to debate whether the provision of this intervention should depend upon whether hospital admission rates are also reduced. A more nuanced analysis, taking account of ‘inappropriate admissions’ [ 23 ] or admissions for ambulatory care sensitive conditions [ 24 ] might be more sensitive to the impact of ACP. It could, though, be asserted that focus on admissions skews analysis towards the priorities of healthcare systems and what we can measure, and away from the priorities of individuals approaching end of life.…”