• Original article (Public health administration) • Previous Articles     Next Articles

Existence of unnecessary hospitalization in in-patient service provision

TAO Jing-jing1, LUO Cheng-zu2, MA Jin1   

  1. 1.School of Public Health, Shanghai Jiaotong University, Shanghai 200025, China; 2.President Office, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2013-08-28 Published:2013-09-16
  • Supported by:

    National Natural Science Foundation of China，71273175； Shanghai Education Committee Foundation，13YS022

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Abstract:

Objective To investigate the existence of unnecessary hospitalization in in-patient service provision, including the proportion of unnecessary admission and unnecessary in-patient days, as well as the distribution of unnecessary in-patient days in the hospitalized stays and in the sample patients. Methods Department of Gynecology and Department of Neurology of Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine were selected as sample. Based on the admissions in 2011, 185 medical records per month were selected from Department of Gynecology, and 100 medical records per month were selected from Department of Neurology. All sample records were selected from patients with admission in December 2011, March 2012 and June 2012. Two nurses conducted the retrospective review of selected records and made the judgments based on the Appropriateness Evaluation Protocol (AEP) criteria. The statistical description of the proportion of unnecessary admission and unnecessary in-patient days was conducted, difference analysis of the proportion of unnecessary days between necessary admission and unnecessary admission was made, and Lorenz curve and Gini coefficient were used to illustrate the distribution of unnecessary days in the sample. Results There were 855 medical records in the sample. The proportion of unnecessary admissions was 14.62%, and that of unnecessary in-patient days was 24.88%. Unnecessary admissions caused more unnecessary days than did necessary admissions, and such differences were statistically significant (P<0.01). Among the successive hospitalized days since admission, the proportion of unnecessary days was gradually higher. Lorenz curve demonstrated that unnecessary days were unevenly distributed among sample patients. Conclusion Unnecessary admissions cause more unnecessary days. Unnecessary days are concentrated among a minority of patients. Short stays do not generate significantly fewer unnecessary days than do longer stays.

Key words: appropriateness evaluation protocol, admission, in-patient day, unnecessary