INAPPROPRIATE HOSPITAL USE BY PATIENTS RECEIVING CARE FOR MEDICAL CONDITIONS - TARGETING UTILIZATION REVIEW

Objective: To describe characteristics associated with inappropriate h ospital use by patients in Manitoba in order to help target concurrent utilization review. Utilization review was developed to reduce inappr opriate hospital use but can be a very resource-intensive process. Des ign: Retrospective chart review of a sample of adult patients who rece ived care for medical conditions in a sample of Manitoba hospitals dur ing the fiscal year 1993-94; assessment of patients at admission and f or each day of stay with the use of a standardized set of objective, n ondiagnosis-based criteria (InterQual). Patients: A total of 3904 pati ents receiving care at 26 hospitals. Outcome measures: Acute (appropri ate) and nonacute (inappropriate) admissions and days of stay for adul t patients receiving care for medical conditions. Results: After 1 wee k, 53.2% of patients assessed as needing acute care at admission no lo nger required acute care. Patients 75 years of age or older consumed m ore than 50% of the days of stay, and 74.8% of these days of stay were inappropriate. Four diagnostic categories accounted for almost 60% of admissions and days, and more than 50% of those days of stay were ina ppropriate. Patients admitted through the emergency department were mo re likely to require acute 1 care (60.9%) than others (41.7%). Patient s who were Treaty Indians had a higher proportion of days of stay requ iring acute care than others (45.9% v. 32.8%). Patients' income and da y of the week on admission (weekday v. weekend) were not predictive fa ctors of inappropriate use. Conclusion: Rather than conducting a utili zation review for every patient, hospitals might garner more informati on by targeting patients receiving care for medical conditions with st ays longer than 1 week, patients with nervous system, circulatory, res piratory or digestive diagnoses, elderly patients and patients not adm itted through the emergency department.