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Effectiveness of a physician-oriented feedback intervention on inappropriate hospital stays
  1. Pedro Antón1,2,
  2. Salvador Peiró1,
  3. Jesús M Aranaz3,
  4. Rafael Calpena4,
  5. Antonio Compañ5,
  6. Edith Leutscher6,
  7. Vicenta Ruíz2
  1. 1Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain
  2. 2Inspección de Servicios Sanitarios, Elche, Spain
  3. 3Servicio de Medicina Preventiva, Hospital Universitario de San Juan, San Juan and Departamento de Salud Pública, Universidad Miguel Hernández, Elche, Spain
  4. 4Servicio Cirugía General, Hospital Universitario de Elche, Elche, Spain
  5. 5Servicio Cirugía General, Hospital Universitario de San Juan, San Juan, Spain
  6. 6Servicio de Medicina Preventiva, Hospital de Villajoyosa, Villajoyosa, Spain
  1. Correspondence to:
 Dr S Peiró
 Fundación Instituto de Investigación en Servicios de Salud, San Vicente 112, 3, 46007 Valencia, Spain; speiro{at}


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.

  • AEP, Appropriateness Evaluation Protocol
  • DRG, Diagnosis-Related Group

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  • This work is part of a research project financed by the Fundación Mapfre Medicina (Mapfre Medical Foundation) (1999/2000) and the Fundación Instituto de Investigación en Servicios de Salud (Institute for Health Services Research Foundation).

  • One of the instruments used in this work, the adeQhos®, has been registered by several of the authors in the public domain. The owners of the copyright have authorised its use for research purposes and activities that contribute to improving healthcare services, as long as the final users implement it free of charge, and cite its source in any documents generated by its use.

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