APPROPRIATENESS OF ADMISSIONS - THE FRENCH EXPERIENCE

The French studies using the Appropriateness Evaluation Protocol (AEP) were developed within the framework of medical audit by local teams, analysing their own practice, in order to improve the quality of care, Four studies were analysed in this review, They were performed in eme rgency departments and data were collected concurrently, The reliabili ty and validity of this French version of the AFP was assessed, The hi gh reliability of the AEP was found to be useful to measure trends or differences between groups, The percentages of inappropriate admission s observed in the studies ranged from 18 to 25%. The hypothesis that t he rate of inappropriate admissions would be highest among the elderly was not confirmed in Paris, Homelessness was the only social factor r elated to a high rate of inappropriate admissions in three of the stud ies, In one study, age and lack of social support were found to be ris k factors for inappropriate admissions, The study of the causes of ina ppropriate admissions was important, since they were to be used as an indicator of systemic problems in the organization of health care deli very, A distinction was made between appropriate and justified admissi ons on both a systemic and an individual level, In conclusion, AFP was found to be an indicator that was both reliable and useful to identif y quality of care problems, Among the factors found to be related to i nappropriate admissions, the internal organization of the hospital pro ved to be one of the main reasons and a target for improvement.