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© 1998 Oxford University Press

research-article

Predictors of inappropriate hospital days in a department of internal medicine

Pierre Choparda, Thomas V Pernegerb,, Jean-Michel Gaspoza, Christian Lovisa, Didier Gousseta, Catherine Rouillarda, François P Sarasina, Pierre-François Ungera, Francis A Waidvogelaa and Alain F Junoda

aDepanment of Internal Medidne, Geneva University Hospitals Geneva Switzerland
bInstitute of Social and Preventive Medicine, University of Geneva CMU, CH-121 I Geneva 4, Switzerland

Reprint requests to: Thomas V Perneger

BACKGROUND: This study aimed to identify predictors of inappropriate hospital days in a deparUnent of internal medicine, as a basis for quality improvement interventions.

METHODS: The appropriateness of 5665 hospital days contributed by 500 patients admitted to the Department of Internal Medicine, Geneva University Hospitals, Switzerland, was assessed by means of the Appropriateness Evaluation Protocol. Predictor variables included patient's age and sex, manner of admission and discharge, and characteristics of hospital days (weekend, holiday, sequence).

RESULTS: Overall, 15% of hospital admissions and 28% of hospital days were rated as inappropriate. In multivariate models, inappropriate hospital days were more frequent among patients whose admission was inappropriate (odds ratio [OR] = 5.3, 95% CI: 3.1–8.4) and among older patients (80–95 years: OR = 3.6. 95% CI: 1.7–7.0, versus <50 years). The likelihood of inappropriateness also increased with each subsequent hospital day, culminating on the day of discharge, regardless of the total length of stay.

CONCLUSIONS: This study identified both the admission and the discharge processes as important sources of inappropriate hospital use in a department of internal medicine. The oldest patients were also at high risk of remaining in the hospital inappropriately. Surprisingly, long hospital stays did not generate a higher proportion of inappropriate days than short hospital stays. This information proved useful in developing interventions to improve the hospitalization process.

Keywords Health services research, hospitalization, appropriateness of health care

Accepted 14 October 1997


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