Assessing the extent to which hospitals are used for acute care purposes

OBJECTIVES. The degree to which Manitobans were appropriately hospitalized for medical conditions was assessed using a retrospective chart review of a sample of patients in 26 hospitals. RESEARCH DESIGN. A standardized set of object-based, nondiagnostic criteria (Inter-Qual) was used by trained abstractors to assess the patient at admi ssion and for each day of stay. RESULTS. A high percentage of admissions and days of care were inappropriat e. Overall, 49.5% of medical patients were acute at the time of admission, 1.6% required no health care services, and 48.9% could have received care t hrough alternate methods or facilities. Only 33.4% of the subsequent days o f stay were appropriate. For patients assessed as acute at the time of admi ssion, by the 8th day of stay, only 47% were still acute and by day 30, onl y 27% were acute. Patients aged 75 years or older were just as likely to be acute at the time of admission as were younger patients; however, they acc ounted for 54% of the days in the study, and fewer than 30% of these days w ere acute. Our data suggest that despite their high use of hospitals, disad vantaged groups (the poor, aboriginal Manitobans), have the same levels of appropriateness as others. CONCLUSIONS. We conclude that alternatives to hospital care must first be e stablished and made known and available before a shift in health care resou rces can occur.