title: Does clinical governance influence the appropriateness of hospital stay?
abstract: BACKGROUND
  Clinical Governance provides a framework for assessing and improving clinical quality through a single coherent program. Organizational appropriateness is aimed at achieving the best health outcomes and the most appropriate use of resources. The goal of the present study is to verify the likely relationship between Clinical Governance and appropriateness of hospital stay.
  
  
  METHODS
  A cross-sectional study was conducted in 2012 in an Italian Teaching Hospital. The OPTIGOV(©) (Optimizing Health Care Governance) methodology was used to quantify the level of implementation of Clinical Governance globally and in its main dimensions. Organizational appropriateness was measured retrospectively using the Italian version of the Appropriateness Evaluation Protocol to analyze a random sample of medical records for each clinical unit. Pearson-correlation and multiple linear regression were used to test the relationship between the percentage of inappropriate days of hospital stay and the Clinical Governance implementation levels.
  
  
  RESULTS
  47 Units were assessed. The percentage of inappropriate days of hospital stay showed an inverse correlation with almost all the main Clinical Governance dimensions. Adjusted multiple regression analysis resulted in a significant association between the percentage of inappropriate days and the overall Clinical Governance score (β = -0.28; p < 0.001; R-squared = 0.8). EBM and Clinical Audit represented the Clinical Governance dimensions which had the strongest association with organizational appropriateness.
  
  
  CONCLUSIONS
  This study suggests that the evaluation of both Clinical Governance and organizational appropriateness through standardized and repeatable tools, such as OPTIGOV(©) and AEP, is a key strategy for healthcare quality. The relationship between the two underlines the central role of Clinical Governance, and especially of EBM and Clinical Audit, in determining a rational improvement of appropriateness levels.
authors.affiliation: Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy. marialucia.specchia@rm.unicatt.it.
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Specchia
authors.affiliation: Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy. andreaposcia83@gmail.com.|Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy. andreaposcia83@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Poscia
authors.affiliation: Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy. massimo.volpe@rm.unicatt.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
authors.affiliation: Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy. pparente87@hotmail.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Parente
authors.affiliation: Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy. silviocapizzi@virgilio.it.
authors.forename: Silvio
authors.initials: S
authors.lastname: Capizzi
authors.affiliation: Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy. acambieri@rm.unicatt.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cambieri
authors.affiliation: Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy. gdamiani@rm.unicatt.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Damiani
authors.affiliation: Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy. wricciardi@rm.unicatt.it.
authors.forename: Walter
authors.initials: W
authors.lastname: Ricciardi
authors.affiliation: Department of Public Health, Catholic University of Sacred Hearth, Largo F.Vito, 1, 00168, Rome, Italy. debelvis@rm.unicatt.it.|Clinical Directorate "A. Gemelli" Teaching Hospital, Largo Gemelli 8, 00168, Rome, Italy. debelvis@rm.unicatt.it.
authors.forename: Antonio Giulio
authors.initials: AG
authors.lastname: De Belvis
mesh_terms: D054869:Clinical Audit; D054976:Clinical Governance; D003430:Cross-Sectional Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies