Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China
ObjectiveThis study aims to investigate the changes in admission appropriateness after patients were admitted and provide a reference for physicians to make admission decisions and for the supervision of medical service behavior by the medical insurance regulatory department.MethodsMedical records o...
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| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1106499/full |
| _version_ | 1797820516943265792 |
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| author | Jingjing Chang Hongxia Gao Hongxia Gao Dai Su Haomiao Li Yingchun Chen Yingchun Chen |
| author_facet | Jingjing Chang Hongxia Gao Hongxia Gao Dai Su Haomiao Li Yingchun Chen Yingchun Chen |
| author_sort | Jingjing Chang |
| collection | DOAJ |
| description | ObjectiveThis study aims to investigate the changes in admission appropriateness after patients were admitted and provide a reference for physicians to make admission decisions and for the supervision of medical service behavior by the medical insurance regulatory department.MethodsMedical records of 4,343 inpatients were obtained based on the largest and most capable public comprehensive hospital in four counties in central and western China for this retrospective study. The binary logistic regression model was employed to examine the determinants of changes in admission appropriateness.ResultsNearly two-in-thirds (65.39%) of the 3,401 inappropriate admissions changed to appropriate at discharge. Age, type of medical insurance, medical service type, severity of the patient upon admission, and disease category were found to be associated with the changes in the appropriateness of admission. Older patients (OR = 3.658, 95% CI [2.462–5.435]; P < 0.001) were more likely to go from “inappropriate” to “appropriate” than younger counterparts. Compared with circulatory diseases, the case evaluated as “appropriate” at discharge was more frequent in the urinary diseases (OR = 1.709, 95% CI [1.019–2.865]; P = 0.042) and genital diseases (OR = 2.998, 95% CI [1.737–5.174]; P < 0.001), whereas the opposite finding was observed for patients with respiratory diseases (OR = 0.347, 95% CI [0.268–0.451]; P < 0.001) and skeletal and muscular diseases (OR = 0.556, 95% CI [0.355–0.873]; P = 0.011).ConclusionsMany disease characteristics gradually emerged after the patient was admitted, thus the appropriateness of admission changed. Physicians and regulators need to take a dynamic view of disease progression and inappropriate admission. Aside from referring to the appropriateness evaluation protocol (AEP), they both should pay attention to individual and disease characteristics to make a comprehensive judgment, and strict control and attention should be paid to the admission of respiratory, skeletal, and muscular diseases. |
| first_indexed | 2024-03-13T09:39:33Z |
| format | Article |
| id | doaj.art-722779b21e0142a3a487fa4d67a3613e |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-03-13T09:39:33Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-722779b21e0142a3a487fa4d67a3613e2023-05-25T04:34:51ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-05-011110.3389/fpubh.2023.11064991106499Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural ChinaJingjing Chang0Hongxia Gao1Hongxia Gao2Dai Su3Haomiao Li4Yingchun Chen5Yingchun Chen6Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaSchool of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaResearch Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, ChinaSchool of Public Health, Capital Medical University, Beijing, ChinaSchool of Political Science and Public Administration, Wuhan University, Wuhan, ChinaSchool of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaResearch Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, ChinaObjectiveThis study aims to investigate the changes in admission appropriateness after patients were admitted and provide a reference for physicians to make admission decisions and for the supervision of medical service behavior by the medical insurance regulatory department.MethodsMedical records of 4,343 inpatients were obtained based on the largest and most capable public comprehensive hospital in four counties in central and western China for this retrospective study. The binary logistic regression model was employed to examine the determinants of changes in admission appropriateness.ResultsNearly two-in-thirds (65.39%) of the 3,401 inappropriate admissions changed to appropriate at discharge. Age, type of medical insurance, medical service type, severity of the patient upon admission, and disease category were found to be associated with the changes in the appropriateness of admission. Older patients (OR = 3.658, 95% CI [2.462–5.435]; P < 0.001) were more likely to go from “inappropriate” to “appropriate” than younger counterparts. Compared with circulatory diseases, the case evaluated as “appropriate” at discharge was more frequent in the urinary diseases (OR = 1.709, 95% CI [1.019–2.865]; P = 0.042) and genital diseases (OR = 2.998, 95% CI [1.737–5.174]; P < 0.001), whereas the opposite finding was observed for patients with respiratory diseases (OR = 0.347, 95% CI [0.268–0.451]; P < 0.001) and skeletal and muscular diseases (OR = 0.556, 95% CI [0.355–0.873]; P = 0.011).ConclusionsMany disease characteristics gradually emerged after the patient was admitted, thus the appropriateness of admission changed. Physicians and regulators need to take a dynamic view of disease progression and inappropriate admission. Aside from referring to the appropriateness evaluation protocol (AEP), they both should pay attention to individual and disease characteristics to make a comprehensive judgment, and strict control and attention should be paid to the admission of respiratory, skeletal, and muscular diseases.https://www.frontiersin.org/articles/10.3389/fpubh.2023.1106499/fullinappropriate admissionsappropriateness evaluation protocoladmission recordsmedical recordsthe change in appropriateness of admission |
| spellingShingle | Jingjing Chang Hongxia Gao Hongxia Gao Dai Su Haomiao Li Yingchun Chen Yingchun Chen Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China Frontiers in Public Health inappropriate admissions appropriateness evaluation protocol admission records medical records the change in appropriateness of admission |
| title | Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China |
| title_full | Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China |
| title_fullStr | Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China |
| title_full_unstemmed | Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China |
| title_short | Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China |
| title_sort | is there a change in the appropriateness of admission after patients were admitted evidence from four county hospitals in rural china |
| topic | inappropriate admissions appropriateness evaluation protocol admission records medical records the change in appropriateness of admission |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1106499/full |
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