Appropriateness of hospital utilisation in Italy

The purpose of this study was to determine the extent of inappropriate hosp ital admission and inappropriate days of stay and the effect of variables o n such inappropriateness on an adult population in Italy. A review was made of medical records of patients admitted to any one of the following specia lities: medicine, surgery, gynaecology or traumatology/orthopaedics at one of five hospitals located respectively in Siena, Frosinone, Rome and Catanz aro. and who were in-patients during one of four pre-selected index days. T o determine the appropriateness of hospital admission and length of hospita lisation, a retrospective application was made using the Italian version of Appropriateness Evaluation Protocol (AEP). A total of 1299 patient days we re reviewed. 14.2% of the hospital admissions and 37.3% of the number of hospitalisation days were judged to be inappropriate. Multiple logistic regression analysi s showed that inappropriate admission was significantly increased with rela tion to: greater distance from hospital to patient's home: admission to a m edical ward; planned admissions; and admission over a weekend. Multiple log istic regression analysis indicated that the inappropriate number of days o f hospitalisation was significantly higher for medicine and for patients wh o were inappropriately admitted. The main reason for categorising an admission as inappropriate was that the patient's problems could be treated on an out-patient basis, and, for inap propriate days of care, the physician was overtly cautious in the managemen t of a patient. Changing the physicians' behaviour and the organisation of hospital activit ies may be effective in improving the quality and efficiency of hospital ca re.