title: Evaluation of quality improvement interventions to reduce inappropriate hospital use.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Geneva University Hospitals, Switzerland. Michel.Picard-Kossovsky@hcuge.ch
authors.forename: Michel P
authors.initials: MP
authors.lastname: Kossovsky
authors.forename: Pierre
authors.initials: P
authors.lastname: Chopard
authors.forename: Filippo
authors.initials: F
authors.lastname: Bolla
authors.forename: François P
authors.initials: FP
authors.lastname: Sarasin
authors.forename: Martine
authors.initials: M
authors.lastname: Louis-Simonet
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Allaz
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Perneger
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gaspoz
mesh_terms: 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