Evaluation of quality improvement interventions to reduce inappropriate hospital use.
OBJECTIVE
To assess the impact of process analyses and modifications on inappropriate hospital use.


METHODS
Pre-post comparison of inappropriate hospital use after process modifications.


METHODS
The Department of Internal Medicine of the Geneva University Hospitals, Switzerland.


METHODS
A random sample of 498 patients.


METHODS
Two processes of care (i.e. non-urgent admissions and transfer to a rehabilitation hospital), which influenced inappropriate hospital use, were identified and modified. The impact of these modifications was then assessed.


METHODS
The proportion of inappropriate hospital admissions and inappropriate hospital days.


RESULTS
As a baseline assessment before quality improvement interventions, the appropriateness of hospital use (admissions and hospital days) was evaluated using the Appropriateness Evaluation Protocol (AEP) in a sample of 500 patients (5665 days). After modification of the two processes through a quality improvement program, inappropriate hospital use was reassessed in a sample of 498 patients (6095 days). Inappropriate hospital admissions decreased from 15 to 9% (P = 0.002) and inappropriate hospital days from 28 to 25% (P = 0.12).


CONCLUSIONS
Using the AEP as a criterion, the quality improvement interventions significantly reduced inappropriate hospital use due to the process of non-urgent admissions, but the reduction of inappropriate hospital days specifically attributed to the transfer to the rehabilitation hospital did not reach statistical significance.
Kossovsky
Michel P
MP
Department of Internal Medicine, Geneva University Hospitals, Switzerland. Michel.Picard-Kossovsky@hcuge.ch
Chopard
Pierre
P
Bolla
Filippo
F
Sarasin
François P
FP
Louis-Simonet
Martine
M
Allaz
Anne-Françoise
AF
Perneger
Thomas V
TV
Gaspoz
Jean-Michel
JM
D000368:Aged; D003430:Cross-Sectional Studies; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D013557:Switzerland; D017749:Total Quality Management / Q000458:organization & administration*; D014600:Utilization Review