Measuring medically unjustified hospitalizations in Switzerland.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_B4B244570A65
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Measuring medically unjustified hospitalizations in Switzerland.
Journal
BMC health services research
Author(s)
Eggli Y., Halfon P., Piaget-Rossel R., Bischoff T.
ISSN
1472-6963 (Electronic)
ISSN-L
1472-6963
Publication state
Published
Issued date
07/02/2022
Peer-reviewed
Oui
Volume
22
Number
1
Pages
158
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Inappropriate use of acute hospital beds is a major topic in health politics. We present here a new approach to measure unnecessary hospitalizations in Medicine and Pediatrics.
The necessity of a hospital admission was determined using explicit criteria related to the recorded diagnoses. Two indicators (i.e. "unjustified" and "sometimes justified" stays) were applied to more than 800,000 hospital stays and a random sample of 200 of them was analyzed by two clinicians, using routine data available in medical statistics. The validation of the indicators focused on their precision, validity and adjustment, as well as their usefulness (i.e. interest and risk of abuse).
Rates, adjusted for case mix (i.e. age of patient, admission planned or not), showed statistically significant differences among hospitals. Only 6.5% of false positives were observed for "unjustified stays" and 17% for "sometimes justified stays". Respectively 7 and 12% of stays had an unknown status, due to a lack of sufficiently precise data. Considering true positives only, almost one third of medical and pediatric stays were classified as not strictly justified from a medical point of view in Switzerland. Among these stays, about one fifth could have probably been avoided without risk. To enable a larger ambulatory shift, recommendations were made to strengthen the ambulatory care, notably regarding post-emergency follow-up, cardiac and pulmonary functions' monitoring, pain management, falls prevention, and specialized at-home services that should be offered.
We recommend using "unjustified stays" and "sometimes justified stays" indicators to monitor inappropriate hospitalizations. The latter could help the planning of reinforced ambulatory care measures to pursue the ambulatory shift. Nonetheless, we clearly advise against the use of these two indicators for hospitals financing purposes.
Keywords
Child, Hospitalization, Hospitals, Humans, Length of Stay, Switzerland/epidemiology, Continuity of patient care, Medicine, Patient admission, Pediatrics, Regional health planning
Pubmed
Web of science
Open Access
Yes
Create date
12/02/2022 15:44
Last modification date
23/01/2024 8:33
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