EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE
Effectiveness of a physician-oriented feedback intervention on inappropriate hospital stays
1 Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain
2 Inspección de Servicios Sanitarios, Elche, Spain
3 Servicio de Medicina Preventiva, Hospital Universitario de San Juan, San Juan and Departamento de Salud Pública, Universidad Miguel Hernández, Elche, Spain
4 Servicio Cirugía General, Hospital Universitario de Elche, Elche, Spain
5 Servicio Cirugía General, Hospital Universitario de San Juan, San Juan, Spain
6 Servicio de Medicina Preventiva, Hospital de Villajoyosa, Villajoyosa, Spain
Correspondence to:
Correspondence to:
Dr S Peiró
Fundación Instituto de Investigación en Servicios de Salud, San Vicente 112, 3, 46007 Valencia, Spain; speiro{at}comv.es
Objective: To evaluate the effectiveness of a combined intervention to reduce inappropriate hospital stays.
Design: Quasi-experimental pre-test/post-test with a non-equivalent control group.
Setting: Three teaching hospitals in the National Health System in Alicante, Spain.
Study participants: Intervention group (2 Surgical Units with 1451 hospital stays) and control group (1 Surgical Unit with 1268 hospital stays).
Intervention: Structured oral presentation followed by direct feedback to surgeons about their own percentages of inappropriate stays and daily evaluation of appropriateness by the surgeons during their rounds.
Main outcome measures: Reduction in the percentage of inappropriate stays identified by the Appropriateness Evaluation Protocol during the intervention period compared to the basal period.
Results: The intervention group reduced its percentage of inappropriate stays from 14.3% to 7.9% (absolute reduction: –6.40; 95% CI –10.7 to –2.14; relative reduction: 44.8%), while no changes occurred in the control group. The reduction was in the number of inappropriate stays attributable to the patients’ medical management that went from 12.7% to 5.8% (absolute reduction: –6.92; 95% CI –10.90 to –2.92), while no significant changes occurred in inappropriate stays due to other causes.
Conclusions: A combined intervention of feedback and physician participation in appropriateness evaluations is effective in reducing the percentage of inappropriate hospital stays, particularly those attributable to conservative medical patterns at discharge.
Abbreviations: AEP, Appropriateness Evaluation Protocol; DRG, Diagnosis-Related Group
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J Epidemiol Community Health 2007 61: 89.
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