Abstract
Background
In Italy, hospital admission costs account for nearly 42% of total health expenditure; in the Marche region, this share exceeds 50%. High costs of hospitalization, however, can be partly explained by inappropriate use. The aim of this research was to assess the risk factors associated with inappropriate hospital admissions and stay for acute pediatric patients.
Methods
Clinical records of children from 30 days to 14 years of age admitted to the wards of orthopedics, pediatrics, pediatric isolation, pediatric surgery and pediatric oncohematology at Salesi Pediatric Hospital of Ancona throughout 2004 were reviewed. The Italian Pediatric Appropriateness Evaluation Protocol (PRUO) was used as a tool for assessing inappropriateness of admission and days of stay.
Results
Overall 21.7% (95% CI = 16.1%–22.4%) of hospital admissions and 30.3% (95% CI = 26.0%–34.9%) of days of stay were judged to be inappropriate. Multiple logistic regression analysis indicated that inappropriate admission was significantly associated with type of admission, discharge ward and place of residence. Inappropriateness of stay was significantly higher if admission was to a medical ward and if admission itself was judged inappropriate.
Conclusions
In a socioeconomic context in which reducing waste is necessary, ineffective health care interventions are no longer tolerable. As a tool capable of integrating each patient’s specific features with those of the health care process, the pediatric PRUO could be a valid tool in the hands of managers for monitoring the appropriateness of admission and stay.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Angelillo IF, Ricciardi G, Nante N et al (2000) Appropriateness of hospital utilisation in Italy. Public Health 114(1):9–14
Bianco A, Pileggi C, Trani F, Angelillo IF (2003) Appropriateness of admissions and days of stay in pediatric wards of Italy. Pediatrics 112:124–128
Bindman AB, Grumbach K, Osmond D et al (1995) Preventable hospitalisations and access to health care. JAMA 274(4):305–311
Chiaradia G, de Waure C, La Torre G, Paparatti M, Ricciardi W (2008) Appropriateness of admission and hospital stay in pediatric wards: the case of a teaching hospital in Rome. Ann Ig 20(1):17–27 (in Italian)
Decreto del Presidente del Consiglio dei Ministri. Definizione dei livelli essenziali di assistenza. 29 novembre 2001 (Decree of the President of the Council of Ministers. Definition of essential services level. November 29th 2001)
Decreto Legislativo 229/99. Norme per la razionalizzazione del Servizio sanitario nazionale. 19 giugno 1999 (Legislative Decree n. 229/99. Rules to rationalize National Health Service)
Decreto Legislativo n. 502. Riordino della disciplina in materia sanitaria. 30 dicembre 1992 (Legislative Decree n. 502. Health discipline reform December 30th 1992)
Esmail A, Quayle JA, Roberts C (2000) Assessing the appropriateness of paediatric hospital admissions in the United Kingdom. J Public Health Med 22:231–238
Formby DJ, Mc Mullin ND, Danagher K, Oldham DR (1991) The Appropriateness Evaluation Protocol: Application in an Australian children’s hospital. Aus Clin Rev 11:123–131
Gertman PM, Restuccia JD (1981) The appropriateness evaluation protocol: a technique for assessing unnecessary days of hospital care. Med Care 19:855–871
Gloor JE, Kissoon N, Joubert GI (1993) Appropriateness of hospitalisation in a Canadian pediatric hospital. Pediatrics 91:70–74
Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley & Sons, New York
Katz M, Warshawssky SS, Porat A, Press J (2001) Appropriateness of pediatric admissions to a tertiary care facility in Israel. Isr Med Assoc 3:501–503
Kemper KJ (1988) Medically inappropriate hospital use in a pediatric population. N Engl J Med 318:1033–1037
Oterino D, Martínez A, González Fouces I, Peiró S (1999) Is it necessary to hospitalize so many children for so many days? Unnecessary pediatric hospitalisation Ann Esp Pediatr 50:373–378 (in Spanish)
Perrin JM, Homer CJ, Berwick DM (1989) Variation in rates of hospitalisation of children in three urban communities. N Engl J Med 320:1183–1187
Poppa G, La Torre G, Mannocci A et al (2009) Appropriateness of admission and stay in obstetrics wards: a new tool assessing unnecessary days of hospital care. Ital J Public Health 6(4):341–351
Progetto ministeriale “concettualizzazione, sviluppo e valutazione di strumenti di osservazione e di intervento che aumentino l’uso appropriato dell’ospedale per acuti” (Ministerial Project “Development and evaluation of tools to promote an appropriate acute hospital use). [cited 2009 July 13]. Available from: http://www.sanita.fvg.it/ars/specializza/programmi/covegno/Manuals.htm
Siliquini R, Rocca N, Rocca G, Minniti D, Gianino MM, Renga G (2005) Understanding inappropriate hospital admissions of patients presenting to the Emergency Department. Ital J Public Health 2(2):33–411
Smith HE, Sheps S, Matheson DS (1993) Assessing the utilization of in-patient facilities in a Canadian pediatric hospital. Pediatrics 92:587–593
The InterQual review system. Marlborough (MA): InterQual Products Group;1996
The Managed Care Appropriateness Protocol. Wellesley (MA): Oak Group;1996
Waldrop R, Peck GQ, Hutchinson S, Randall Z (1998) Comparison of pediatric hospitalisation using the Pediatric Appropriateness Evaluation Protocol at three diverse hospitals in Louisiana. J La State Med Soc 150:211–217
Acknowledgement
We would like to thank Luca Valerio for his valuable linguistic revision of the manuscript.
Conflict of Interest
The authors declare to have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vincitorio, D., Chiaradia, G., de Waure, C. et al. Appropriateness of admission and days of stay in pediatric hospital in Ancona, Italy. J Public Health 18, 497–503 (2010). https://doi.org/10.1007/s10389-010-0325-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10389-010-0325-y