Prevalence and determinants of inappropriate admission and hospitalization in Iran: A systematic review and meta-analysis

Kouhestan, Seyyed Mostafa; Hashempour, Reza; Raei, Behzad; Chivaee, Dariush; Safari, Hossein

doi:10.47176/mjiri.34.2

Cited by 5 publications

(5 citation statements)

References 19 publications

(25 reference statements)

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“…[30][31][32][33] The prevalence of inappropriate admissions of 11.9% is consistent with the results obtained by Kouhestan et al in a meta-analysis conducted in 2020, which found an incidence of 11.0%. 34 The prevalence in this study also occupies an intermediate position compared with earlier studies, which registered variable frequencies depending on the care unit studied and the type of admission analyzed. Thus, incidence rates of inappropriate admissions range from 4.5% in Ochoa-Gomez et al, Spain, 2002, among patients in an emergency unit 15 to 26.1% in Hammond et al, UK, 2009, in a unit for patients with long-term neurological impairment.…”

Section: Discussionsupporting

confidence: 45%

Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach

Jose-Saras

Vicente-Guijarro

Sousa³

et al. 2023

J GEN INTERN MED

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Background Inappropriate hospital admissions compromise the efficiency of the health care system. This work analyzes, for the first time, the prevalence of inappropriate admission and its association with clinical and epidemiological patient characteristics. Objectives To estimate the prevalence, associated risk factors, and economic impact of inappropriate hospital admissions. Design and Participants This was a cross-sectional observational study of all hospitalized patients in a high complexity hospital of over 901 beds capacity in Spain. The prevalence of inappropriate admission and its causes, the association of inappropriateness with patients’ intrinsic risk factors (IRFs), and associated financial costs were analyzed with the Appropriateness Evaluation Protocol in a multivariate model. Main Measures and Key Results A total of 593 patients were analyzed, and a prevalence of inappropriate admissions of 11.9% (95% CI: 9.5 to 14.9) was found. The highest number of IRFs for developing health care-related complications was associated with inappropriateness, which was more common among patients with 1 IRF (OR [95% CI]: 9.68 [3.6 to 26.2.] versus absence of IRFs) and among those with surgical admissions (OR [95% CI]: 1.89 [1.1 to 3.3] versus medical admissions). The prognosis of terminal disease reduced the risk (OR [95% CI]: 0.28 [0.1 to 0.9] versus a prognosis of full recovery based on baseline condition). Inappropriate admissions were responsible for 559 days of avoidable hospitalization, equivalent to €17,604.6 daily and €139,076.4 in total, mostly attributable to inappropriate emergency admissions (€96,805.3). Conclusions The prevalence of inappropriate admissions is similar to the incidence found in previous studies and is a useful indicator in monitoring this kind of overuse. Patients with a moderate number of comorbidities were subject to a higher level of inappropriateness. Inappropriate admission had a substantial and avoidable financial impact.

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Section: Discussionsupporting

confidence: 45%

Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach

Jose-Saras

Vicente-Guijarro

Sousa³

et al. 2023

J GEN INTERN MED

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“…The present study indicated that, married patients were approximately 2.65 times more likely to be hospitalized inappropriately than single patients. In a systematic review, Kouhestani et al showed that the percentage of inappropriate stays was higher among married people (16.1%) than single ones (10.9%) [ 33 ]. It is likely that married people are older than single ones; therefore, the older the patients are, the more they use health services.…”

Section: Discussionmentioning

confidence: 99%

“…Any improper use of operating rooms could lead to delays in providing care to the patients and as a result, imposes costs on healthcare institutions. According to Kouhestani, physician-related factors accounted for most inappropriate hospitalizations since delays in surgeries or not having access to treating physicians could cause such hospitalizations [ 33 ]. Similarly, Ravangard et al and Mosadeghrad et al found that Factors causing inappropriate stay include physicians’ specialty, discharge time, rescheduled surgeries, lack of regular attendance of doctors, delay in consultations [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Rate and causes of inappropriate stays and the resulting financial burden in a single specialty burns hospital

Moradi

Bagherzadeh

et al. 2022

BMC Health Serv Res

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Background One of the most important challenges facing hospitals is inappropriate admissions and stays the reduction of which can contribute to a decline in healthcare costs without reducing the quality of services. The aim of this study was to estimate the rate and causes of inappropriate stays and their financial burden in a single specialty burns hospital. Methods This is mixed methods study conducted in 2021. In the quantitative phase, all medical records of patients admitted to a burn hospital were reviewed and 260 cases were randomly selected. The records were evaluated based on the Appropriateness Evaluation Protocol to estimate the rate and preliminary causes of inappropriate stays and their direct costs. Frequencies and logistic regression were used for the rates and the influential factors in causing inappropriate stay, respectively. In the qualitative phase, 13 senior and middle managers of the hospital were interviewed for their interpretation of the quantitative data and the main causes of inappropriate stays. Qualitative data were analyzed by using Graneheim-Lundman method. Results About 28.5% of the patients had at least 1 day of inappropriate stay and about 6% of the total hospitalization days were inappropriate. Marital status, insurance status, and the length of stay were significantly associated with inappropriate admission (p < 0.05). In addition, the annual inappropriate admission days and the direct cost imposed on the patients were estimated at 1490 days and $ 66,848.17. The main causes of inappropriate stays are categorized under themes of healthcare providers, service recipients, financial issues, extra-organizational features, and equipment. Conclusion A significant percentage of patients experience inappropriate admissions. The number of inappropriate stays, which imposes a high cost on patients, can be reduced by considering the standard criteria for appropriate admissions. In addition, hospital officials can prevent inappropriate stays as much as possible and reduce the costs and increase the productivity of hospitals through proper management and planning as well as a regular monitoring of physicians and patients.

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“…Health has always been one of the most important concerns and basic human needs [ 1 ] and the government is not only responsible for meeting these needs [ 2 ] but also is responsible for the financial protection of individuals and households from health expenditures [ 3 ]. Taxes, insurance, and out-of-pocket payments are the most common methods of financing health care services [ 4 ], each of which has different effects on health system indicators, and some of its forms, such as out-of-pocket payments, may result in corruption [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic inequality in informal payments for health services among Iranian households: a national pooled study

et al. 2023

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Background There is limited evidence on the prevalence and socioeconomic inequality in informal payments (IP) of households in the Iranian health system. This study was conducted to investigate the prevalence of IP and related socioeconomic inequalities among Iranian households in all provinces. Method Data on Household Income and Expenditure Surveys (HIES) for 91,360 households were used to examine the prevalence and inequality in informal health sector payments in the years 2016 to 2018. The Normalized Concentration Index (NC) was used to examine inequality in these payments and the decomposition analysis by the Wagstaff approach was used to determine the share of variables affecting the measured inequality. Results Of the total households, 7,339 (7.9%) reported IP for using health services. Urban households had higher IP (10%) compared to rural ones (5.42%). Also, the proportion of households with IP in 2016 (11.69%) was higher than in 2017 (9.9%), and 2018 (4.60%). NC for the study population was 0.129, which shows that the prevalence of IP is significantly higher in well-off households. Also, NC was 0.213 (p < 0.0001) and -0.019 for urban and rural areas, respectively (p > 0.05). Decomposition analysis indicated that income, sex of head of household, and the province of residence have the highest positive contribution to measured inequality (with contributions of 156.2, 45.8, and 25.6%, respectively). Conclusion There are a significant prevalence and inequality in IP in Iran's health system and important variables have shaped it. On the whole, inequality was pro-rich. This may lead to increasing inequality in access to quality services in the country. Our findings showed that previous health policies such as regulatory tools, and the health transformation plan (HTP) have not been able to control IP in the health sector in the desired way. It seems that consumer-side policies focusing on affluent households, and high-risk provinces can play an important role in controlling this phenomenon.

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Prevalence and determinants of inappropriate admission and hospitalization in Iran: A systematic review and meta-analysis

Cited by 5 publications

References 19 publications

Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach

Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach

Rate and causes of inappropriate stays and the resulting financial burden in a single specialty burns hospital

Socioeconomic inequality in informal payments for health services among Iranian households: a national pooled study

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