RISK-FACTORS FOR A MEDICALLY INAPPROPRIATE ADMISSION TO A DEPARTMENT OF INTERNAL-MEDICINE

Objective: To identify patient- and admission-related risk factors for a medically inappropriate admission to a department of internal medic ine. Methods: Cross-sectional study of a systematic sample of 500 admi ssions to the department of internal medicine of an urban teaching hos pital. The appropriateness of each admission and reasons for inappropr iate admissions were assessed using the Appropriateness Evaluation Pro tocol. Risk factors included the time (day of week and holidays) and m anner (through emergency department or direct admission) of admission, patient age and sex, health status of patient and spouse, living arra ngements, formal home care services, and informal support from family or friends. Results: Overall, 76 (15.2%) hospital admissions were rate d as medically inappropriate by the Appropriateness Evaluation Protoco l. In multivariate analysis, the likelihood of an inappropriate admiss ion was increased by better physical functioning of the patient (odds ratio [OR], 1.5; 95% confidence interval [Cl], 1.1-2.1 [for 1 SD in Ph ysical Functioning scores]), lower mental health status of the patient 's spouse (OR, 2.6; 95% CI, 1.3-5.6), receipt of informal help from fa mily or friends (OR, 3.3; 95% CI, 1.5-7.2), and hospitalization by one 's physician (OR, 3.6; 95% CI, 1.7-7.5). Receiving formal adult home c are was not associated with inappropriateness of hospitalization. Conc lusions: Inappropriate admissions to internal medicine wards are deter mined by a mix of factors, including the patient's health and social e nvironment. In addition, the private practitioners' discretionary abil ity to hospitalize their patients directly may also favor medically in appropriate admissions.