Clinical question: How prevalent and costly are inappropriate hospital admissions and are patients’ intrinsic risk factors (IRFs) or comorbidities associated with inappropriate hospital admissions?
Background: Health care resource overuse (inappropriate hospital admissions) has a significant economic impact on U.S. health care spending. While previous studies have focused on the frequency and non-clinical patient factors linked to improper hospital admissions, this article explores the economic consequences of such admissions and the connection between IRFs or comorbidities and inappropriate hospital admissions using the Appropriateness Evaluation Protocol (AEP).
Study design: Cross-sectional, descriptive, observational study
Setting: Hospitalized patients in a high-acuity, 901-bed hospital in Spain
Synopsis: 593 patients were analyzed, revealing an 11.9% prevalence of inappropriate admissions. Patients with one or two IRFs were more likely to experience inappropriate hospital admission (16.9%, versus 2.7% among those with 0 IRFs; P=0.036), with the association being stronger than for those with more than three IRFs. Inappropriateness was also significantly higher among patients with a likelihood of recovery with residual disability (16.5%, versus 12.1% among patients with a prognosis of full recovery; P=0.003) and among patients with scheduled admissions (18.4%, versus 8.7% among those with urgent admissions; P <0.001). Surgical admissions were also associated with a higher risk of inappropriateness (17.9%, versus 7.6% among those with medical admissions; P <0.001). The main causes of inappropriate admission were premature admission (56.3%) and the potential for outpatient management (39.3%). Premature admissions were noted in 78.4% of planned admissions, and 58.8% of urgent admissions had the potential for outpatient management. Inappropriate admissions resulted in 559 avoidable hospital days, with a total cost overrun of $151,618.31.
Bottom line: Inappropriate hospital admissions are a significant issue with economic implications. Focusing on admission practices for patients with moderate comorbidities and improving outpatient care networks may mitigate the financial impact of inappropriate hospital admissions.
Citation: San Jose-Saras, et al. Inappropriate hospital admission according to patient intrinsic risk factors: an epidemiological approach. J Gen Intern Med. 2023;38(7);1655-63.
Dr. Duncan
Dr. O’Dorisio
Dr. Duncan is a clinical assistant professor and Dr. O’Dorisio is a clinical associate professor in the division of hospital medicine at The Ohio State University Wexner Medical Center in Columbus, Ohio.