[Impact of a clinical self-evaluation intervention on the appropriateness of hospital stays].
OBJECTIVE
To assess the impact of an intervention on inappropriate hospital stays (IHS) in acute-care hospitals in Catalonia (Spain) with the aim of testing the hypothesis that a simple intervention (adeQhos) reduces the proportion of IHS.


METHODS
A pre-test/post-test study was performed through the <<adeQhos>> questionnaire. Two intervention groups (internal medicine and general surgery) and 2 control groups (other medical specialities, orthopedics) were compared in 10 acute-care hospitals in Catalonia. The same evaluators assessed appropriateness of hospital stays before and after the intervention, using the Appropriateness Evaluation Protocol.


RESULTS
A total of 1,594 pre-test stays and 1,495 post-test stays were reviewed. Of all the stays reviewed (day before discharge), 41.1% were inappropriate. The intervention was applied to 4,613 stays. There was a significant increase of IHS in the medicine control group (from 39.7 to 48.6%), and no decrease in the intervention groups (internal medicine [from 46.7 to 50.6%] or general surgery [from 27.2 to 31.2%]). The correlation between the intensity of the intervention and the difference in IHS before and after the intervention was r = -0.373 (p = 0.106). The intensity of intervention differed among the hospitals. In hospitals with an intensity of intervention > 60%, the proportion of IHS decreased by 10.7 points in internal medicine and by 4.8 points in general surgery, while the proportion of IHS increased in the control groups.


CONCLUSIONS
The prevalanece of IHS the day before discharge in the hospitals studied was high (41.1%). No significant decrease in IHS was observed after a low-intensity intervention.
Monteis Catot
Jaume
J
Hospital General de l'Hospitalet de Llobregat, Consorci Sanitari Integral, Hospitalet de Llobregat, Barcelona, España. jaume.monteis@sanitatintegral.org
Martín-Baranera
Montserrat
M
Soler
Nikita
N
Vilaró
Josep
J
Moya
Carlos
C
Martínez
Francesc
F
Riu
Marta
M
Puig
Carme
C
Riba
Antoni
A
Navarro
Gemma
G
Espinagosa
Assumpta
A
Carrasco Gómez
Genís
G
Castells
Xavier
X
Peiró
Salvador
S
D000368:Aged; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires