title: Causes of inappropriate hospital days: development and validation of a French assessment tool for rehabilitation centres.
abstract: OBJECTIVE
  To develop and validate a list of criteria to assess the causes of inappropriate hospital days for patients admitted to rehabilitation centres and sub-acute care units.
  
  
  METHODS
  The tool was developed by a multidisciplinary panel of 33 experts, using a formalized consensus method. It collects both the needs of patients (distinguishing healthcare needs (9 criteria) and accommodation needs (9 criteria)) and the reasons for inappropriateness (19 criteria). Inappropriate days were identified using the tool to assess appropriateness of hospital days validated previously. Reliability was studied by measuring agreement between two independent simultaneous ratings.
  
  
  METHODS
  The validation study was performed on a randomized sample of 576 hospital days from 22 wards in France.
  
  
  METHODS
  Inter-rater reliability was evaluated using the κ-statistic and prevalence-adjusted and bias-adjusted kappa (PABAK).
  
  
  RESULTS
  For patient accommodation needs, the inter-rater reliability was estimated by a κ-value of 0.80 (95% confidence interval (95% CI) 0.66-0.92) and a PABAK of 0.80 (95% CI 0.63-0.91). There was good agreement on the reasons for inappropriateness, with κ-values from 0.30 to 0.60 and PABAK from 0.46 to 0.69. The κ-coefficient varied from 0.33 to 0.49 for the assessment of patient healthcare needs, with PABAK ranging from 0.49 to 0.72.
  
  
  CONCLUSIONS
  The instrument is suitable and valid to assess the causes of inappropriate hospital days in rehabilitation centres and sub-acute care units. The study showed that the tool can be easily used by healthcare workers, which makes it useful for quality improvement.
authors.affiliation: Evaluation and Therapeutic Patient Education Unit, University Hospital of Nantes, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Paillé-Ricolleau
authors.forename: Christophe
authors.initials: C
authors.lastname: Leux
authors.forename: Romain
authors.initials: R
authors.lastname: Guilé
authors.forename: Hélène
authors.initials: H
authors.lastname: Abbey
authors.forename: Pierre
authors.initials: P
authors.lastname: Lombrail
authors.forename: Leïla
authors.initials: L
authors.lastname: Moret
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D005602:France; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D011787:Quality of Health Care; D012047:Rehabilitation Centers