The evaluation of screening methods to identify medically unnecessary hospital stay for patients with pneumonia.
OBJECTIVE
This study compared three methods to screen charts of pneumonia patients for excess days.


METHODS
A derivation data set was used to statistically derive a severity measure to predict length of stay for pneumonia patients and to refine a clinical algorithm for identifying excess stay. A validation data set was used to compare three computerized methods to screen for unnecessary hospital days: (1) an observed length of stay greater than a target value; (2) an observed stay greater than predicted for the specific patient; and (3) an algorithm that tested whether there were clinical justifications for the entire hospital stay.


RESULTS
The sensitivity and specificity for detecting excess stay for the three methods were (1) 0.48 and 0.85 for the observed stay greater than the target value; (2) 0.56 and 0.73 for observed stay greater than predicted; and (3) 0.83 and 0.85 for the algorithm.


CONCLUSIONS
These results suggest that computerized clinical algorithms may provide a useful method to detect unnecessary hospital stay.
Hartz
A J
AJ
Medical College of Wisconsin, Milwaukee 53226, USA.
Bade
P F
PF
Sigmann
P
P
Guse
C
C
Epple
P
P
Goldberg
K C
KC
D000328:Adult; D000368:Aged; D000465:Algorithms; D017714:Community-Acquired Infections / Q000191:economics; D003363:Cost Control; D003625:Data Collection; D005260:Female; D006300:Health Services Misuse / Q000191:economics* / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D016347:Medical Records Systems, Computerized / Q000191:economics; D008875:Middle Aged; D011014:Pneumonia / Q000191:economics*; D011015:Pneumonia, Aspiration / Q000191:economics; D012984:Software; D014600:Utilization Review / Q000379:methods*; D014922:Wisconsin