Therefore, a basis is formed on which to reduce the inappropriate admissions after the correct rates are determined (Restuccia, Shwartz, Ash, and Payne, 1996).
The connection between hospitalization rates and the inappropriateness of the admissions cannot be confirmed. A study of adults revealed that there was no link between the rates of hospitalization and the inappropriateness of the admission while a similar study conducted with no age limits produced contrary results. Three procedures of coronary angiography, upper gastrointestinal endoscopy, and carotid endarterectomy were used in another study to find out the relationship between the varying admission rates and their appropriateness (Restuccia, Shwartz, Ash, and Payne, 1996).
It was revealed that there was more inappropriateness in high-use areas. When this study was repeated for a small area, the outcomes were quite different. This showed that inappropriateness cannot be used as a basis to find out the cause for the differing hospitalization rates (Restuccia, Shwartz, Ash, and Payne, 1996). These studies have two major limitations. First and foremost, mainly the target of the studies has been to investigate large geographical regions that might have neglected the basic factors present in the small areas, the localized patterns of medical practices and the varying hospitalization rates that are crucial for scientific and policy related studies. Secondly, the focus of the study was either on procedural admissions or on the combination of medical and surgical admissions. Thus, the factors underlying hospital admissions rates were largely ignored (Restuccia, Shwartz, Ash, and Payne, 1996).
Another study was undertaken with the purpose of predicting the number of inappropriate hospital days in an internal medicine department so that quality enhancing measures could be properly adopted (Chopard, Gaspoz, Lovis, et al., 1998). The study was undertaken on the basis of Appropriateness Evaluation Period that attempted to determine the appropriateness of 5665 days in the hospital stayed by 500 patients in the Department of Internal Medicine, Geneva University Hospital, Switzerland. Some of the predicting factors that were considered were the patient's age, gender, the ways of admission and discharge and the nature of the days spent in the holidays (Chopard, Gaspoz, Lovis, et al., 1998).
The overall results revealed that 15% of the medical admissions and 28% of the hospital days were inappropriate. In other models of study, inappropriate admissions of patients were also accompanied by unnecessary hospital stays. The possibility of inappropriateness of the stay rose with each extra hospital day stayed ending on the day of discharge (Chopard, Gaspoz, Lovis, et al., 1998).
The study concluded that both the manners of admission and discharge were significant ways of discerning the appropriateness of hospital use in the Department of Internal Medicine. Even the longest staying patients were likely to stay further unnecessarily. However, longer hospital stays did not indicate a high rate of inappropriateness in the hospital and neither did shorter stays depict a lower rate. This piece of information became crucial in improving the health care services (Chopard, Gaspoz, Lovis, et al., 1998).
Another study was conducted with the objective of signifying that the high rate of inappropriateness in hospital use can be curbed by reducing the provision of medical care and saving resources. It identified the possibility of health gains and the costs from admissions to the Department of Internal Medicine (Eriksen, Kristiansen, Nord, Pape, Almdahl, Hensrud, Jaeger, 1998).
It made use of two expert panels which included an internist, a surgeon and a GP. They approximated the gains in DeltaHYE, or the healthy year equivalents and the advancement in the quality of life after the hospital stay, DeltaSTQoL, following the admissions to the department. The period was of six weeks (Eriksen, Kristiansen, Nord, Pape, Almdahl, Hensrud, Jaeger, 1998).
The expert panels were given the task of gauging each admission with the help of summary information provided in relation to the stay. The computation of costs was done by allocating the nursing, doctor services, and the hospital costs in line with the duration of the stay for each admitted patient and by recording all remedial interventions. The step down allocation method was used to allocate the overhead costs to the departments (Eriksen, Kristiansen, Nord, Pape, Almdahl, Hensrud, Jaeger, 1998).
The results showed that 17% of the patient benefited from no health gains whereas 83% had gains. The costs of the non-health gaining 17% made up 7% of the total costs of wards and the 22% with a low degree of DeltaSTQoL made up for 16%. The study concluded that the savings made from excluding no-gain patients from admission would have been self-effacing. It showed that 23% of the total costs could have been saved by excluding the patients with a low degree of DeltaSTQoL too (Eriksen, Kristiansen, Nord, Pape, Almdahl, Hensrud, Jaeger, 1998).
A further study was undertaken with the objective of describing characteristics related to inappropriate hospital use in Manitoba to help focus on utilization review. This review which requires a high use of resources can be an important tool for the identification of ways to curb increasing hospital costs. A total of 3904 patients were examined who were benefiting from health care at 26 different hospitals. The appropriate and inappropriate hospital use was studied along with the duration of the stay at hospitals by patients (DeCoster, Roos, Carriere, Peterson, 1997).
After a week, the results showed that about 53.2% of the patients who were entitled to receive acute health care did not require it any longer. 50% of the days of stay were utilized by patients who were 75 years old or older. Also, 74.8% of these hospital days were revealed to be inappropriate. The four diagnostic categories formed up to a 60% of admissions and days while more than 50% of them were inappropriate. Patients admitted by emergency departments stayed longer and required more acute care. The factors of patient's incomes and the nature of the days was not a useful tool in determining the appropriateness of hospital use (DeCoster, Roos, Carriere, Peterson, 1997).
The study concluded that it is more informative and economical for the hospitals to gain insight into the appropriateness of hospital use by knowing their patients, their duration of stay, diagnosis, and the nature of their admission instead of using expensive utilization review for every patient (DeCoster, Roos, Carriere, Peterson, 1997).
One more study was conducted targeting the appropriateness of hospital use and it aimed to develop a connection between the hospital admission and stay of the adult population with the inappropriateness of either admission or stay. A modified version of Appropriateness Evaluation Protocol (AEP) was used on a sample of 1082 patients staying in the hospital (Apolone, Fellin, Tampieri, et al., 1997).
The results indicated that 27% of the total admissions and 40% of the stays were inappropriate. The rate of inappropriate admissions was related to the nature of the day of admission and also presented a connection with the age of the patient. It was concluded that quite a major part of hospital use was known to be inappropriate. The properties of high interrelated reliability and predictability of expected associations in AEP was ascertained (Apolone, Fellin, Tampieri, et al., 1997).
Inappropriate hospital admissions during the 21st century
By the end of the 20TH century a pioneering research study found that the main hospital entrants are usually sent by the emergency departments. The rest of the patients are mostly sent over by the doctors for elective surgery or childbirth. The authority to admit and discharge any patient lied only with the physician. It should be noted, however, that physicians can only admit patients in those hospitals in which the physicians enjoy admitting privileges. They do not have the authority to admit patients in any hospital of their choice (Oahai Manual, 1999).
There is a procedural way of being eligible for the privileges. It is only when all the procedures are done with and the process completed, that the physician is granted the privilege to bring hospital entrants into the hospital. It is the job of the hospital to decide the extent of privileges a physician is entitled to and a hospital can withhold or allow privileges as it deems fit. Even if the physician still wants to admit the patient to another hospital, the physician of the other hospital who is granted admitting privileges will need to be consulted (Oahai Manual, 1999). These findings have been confirmed by Owens and Elixhauser (2006a; 2006b) in their study. They also found that the main hospital entrants are usually sent by the emergency departments. Their findings have been summarized below:
In the year 2003, ED dealt with 55% of 29.3 million hospital admissions after excluding admissions due to pregnancy and childbirth (Owens and Elixhauser, 2006a).
It was also discovered that in accordance with the population of a particular region, people living in the Northeast are more likely to enter hospital through ED as compared to Western people (Owens and Elixhauser, 2006a).
Medicare and Medicaid cover 66% of all the admissions through ED…