Background: This study was carried out to evaluate the hypothesis that the proportion of inadequate hospital admissions and days is greater in patients with pulmonary neoplasm than in patients with chronic obstructive pulmonary disease (COPD) given the therapeutic and diagnostic features of both diseases and to establish the applicability of the Appropriateness Evaluation Protocol (AEP).
Methods: A retrospective review was performed of the medical records of patients admitted for COPD and pulmonary neoplasm. Two external physicians reviewed the clinical histories using the AEP. Admissions and hospital days considered as potentially inadequate by the reviewers were supervised by a clinical epidemiological panel which confirmed and identified the causes for inadequacy. One hundred sixty-six patients admitted with COPD and 79 with pulmonary neoplasm selected by a systematic sample of admissions whose principal diagnosis was COPD or pulmonary neoplasm were studied over one year in a tertiary level teaching hospital in Barcelona.
Results: It was found that 4.8% of the admissions with COPD and 15.5% of the days of hospital stay were inappropriate while in patients with pulmonary neoplasm 14% of the admissions and 40% of the days of hospital stay were inappropriate. The main causes of inadequacy were: social (33.3% in patients with COPD); patients inadequately admitted but who remained in hospital to undergo diagnostic tests which could have been performed on an out patients basis (46% in patients with pulmonary neoplasm).
Conclusions: Inappropriateness was greater in admissions and in hospital days with greater diagnostic components (pulmonary neoplasm) than in fundamentally therapeutic cases (COPD). The Appropriateness Evaluation Protocol was valid in this hospital with the supervising panel being very useful in the judgement of cases not clearly established in the protocol. The level of inadequacy was found to be similar to that of other studies although the results are not directly comparable.