Appropriateness of Admissions: the French Experience

• Published in: International journal for quality in health care Vol. 7; no. 3; pp. 233 - 238
• Main Authors: LANG, THIERRY, DAVIDO, ALAIN, LOGEROT, HÉLÈNE, MEYER, LAURENCE
• Format: Journal Article
• Language: English
• Published: England PERGAMON 01.09.1995
• Subjects: Age Factors; Aged; APPROPRIATENESS OF HOSPITAL USE: THE EUROPEAN BIOMED PROJECT; Concurrent Review - organization & administration; Emergency Service, Hospital - statistics & numerical data; Female; France; Health Services Research; Hospitals, Teaching - statistics & numerical data; Hospitals, Urban - statistics & numerical data; Humans; Male; Medical Audit; Middle Aged; Patient Admission - standards; Reproducibility of Results; Risk Factors
• ISSN: 1353-4505; 1464-3677
• DOI: 10.1093/intqhc/7.3.233

The French studies using the Appropriateness Evaluation Protocol (AEP) were developed within the framework of medical audit by local teams, analysing their own practice, in order to improve the quality of care. Four studies were analysed in this review. They were performed in emergency departments and data were collected concurrently. The reliability and validity of this French version of the AEP was assessed. The high reliability of the AEP was found to be useful to measure trends or differences between groups. The percentages of inappropriate admissions observed in the studies ranged from 18 to 25%. The hypothesis that the rate of inappropriate admissions would be highest among the elderly was not confirmed in Paris. Homelessness was the only social factor related to a high rate of inappropriate admissions in three of the studies. In one study, age and lack of social support were found to be risk factors for inappropriate admissions. The study of the causes of inappropriate admissions was important, since they were to be used as an indicator of systemic problems in the organization of health care delivery. A distinction was made between appropriate and justified admissions on both a systemic and an individual level. In conclusion, AEP was found to be an indicator that was both reliable and useful to identify quality of care problems. Among the factors found to be related to inappropriate admissions, the internal organization of the hospital proved to be one of the main reasons and a target for improvement. Los estudios franceses que utilizaron el Appropriateness Evaluation Protocol (AEP) se desarrollaron en el marco del audit médico por equipos locales que analizaron su propia práctica, con el objetivo de mejorar la calidad asistencial. En esta revisión se analizaron cuatro estudios. Se realizaron en sercicios de urgencias y los datos se colectaron de forma concurrente. Se evaluó la fiabilidad y validez de la versión francesa del AEP. La gran fiabilidad del AEP fue muy útil para medir tendencias o diferencias entre grupos. Se observó un porcentaje de ingresos inadecuados entre el 18 y el 25%. La hipótesis que la tasa de inadecuación sería más alta en los ancianos no se confirmó en Paris. Las personas sin hogar fueron el único factor social relacionado con una tasa alta de inadecuación en los tres estudios. En un estudio, se observó que la edad y la falta de soporte social eran factores de riesgo do los ingresos inadecuados. El estudio de las causas de los ingresos inadecuados fue importante, ya que dichas causas se utilizaron como un indicador de los problemas de la atención sanitaria. Se estableció una distinción entre ingresos adecuados e ingresos justificados, tanto a nivel general como individual. En conclusión, el AEP fue un buen indicador que fue a la vez fiable y útil para identificar problemas de calidad en la atención sanitaria. Entre los factores relacionados con los ingresos inadecuados, se demostró que la organización interna del hospital fue una de sus causas principales y un objetivo a mejorar.