Appropriateness Assessment Of Hospital Admission And Length Of Stay By AEP: A Preliminary Study

Objective: The purpose of this study was to provide a general framework of assessingthe appropriateness of hospital admission and days of stay by AEP based onappropriateness assessment theory. Meanwhile, a domestic protocol of assessing theappropriateness of hospital admission and stay was established. By using the protocolestablished before to analyze the extent of inappropriate hospital use and the factorsrelated to variations in appropriateness, so that sorting out the problems in medicalsystem, hospital management or resource allocation and providing references for furtherresearch.Methods: Literature mining was used to determine the origin, background anddevelopment of appropriateness assessment and to analyze the scientific nature andlimitation of appropriateness assessment protocol. Then18medical review physiciansfrom a tertiary care hospital were selected and Delphi technique was used to collecttheir ratings and comments on the feasibility of AEP and medical record availability.The new version of the AEP, labeled N-AEP, was then established. Finally, patientsadmitted from ER in the sample hospital were investigated and the appropriateness ofhospital use and factors were analyzed by N-AEP.Results:(1) A general framework of assessing the appropriateness of hospital admissionand stay based on AEP was provided according to the research of the appropriatenessassessment theory.(2) The new version of the AEP, labeled N-AEP was established,which consisted of criteria of appropriateness of hospital admission and stay. Thecriteria of appropriateness of hospital admission was divided into two subsets pertainingto intensity of service (n=4) and severity of illness (n=10), and the criteria of appropriateness of hospital stay was divided into three subsets pertaining to medicalservices (n=10), nursing service (n=6) and patient condition (n=8).(3)17.12%ofadmissions and20.76%of hospital stays for the patients admitted from ER was judgedto be inappropriate according to the application of N-AEP. Inappropriate stay wassignificantly associated with age and season of admission.Conclusion: The appropriateness assessment theory was systematically investigated andthe N-AEP system established by using Delphi was feasible and applicable. Meanwhile,after analyzed the application of AEP in the sample hospital, we provided references forhospital to find problems and organization to diagnosis. The study was on its debut, andfurther research needed to be taken.