APPROPRIATENESS OF HOSPITAL USE - AN OVERVIEW OF ITALIAN STUDIES

This paper reports on the general features and findings of 11 studies conducted in Italy on appropriateness of hospital admission and days o f stay using the Appropriateness Evaluation Protocol (AEP), Studies ha ve been grouped for presentation in two categories, The first comprise s six heterogeneous studies illustrating different ways of targeting t he use of the AEP: two used it to assess appropriateness of admission in an emergency room setting, two measured appropriateness of days of stay in patients with AIDS and nosocomial infections and finally two o thers evaluated hospital days in a group of elderly patients and ''bef ore and after'' the institution of a domiciliary nursing service, resp ectively, The second group comprises five more homogeneous utilization review studies aimed at assessing inappropriateness of admissions and days of stay in medical/surgical departments of large hospitals in no rthern Italy, Besides detecting a substantial amount of inappropriaten ess in admission (range = 25-38%) and days of stay (range = 28-49%) th is latter group of studies suggests that delays in execution and repor ting of laboratory investigations, unavailability of operating rooms a nd delays due to difficulties in transferring patients to long-term ca re facilities are the most common causes of inappropriate days of stay , Despite the differences in their objectives, design and methods of s ampling, these studies indicate that an explicit, diagnosis-independen t and standardized instrument such as the AEP can help to uncover a su bstantial amount of the potentially avoidable use of hospital resource s in the Italian context.