Objective: To evaluate the effectiveness of interventions aimed at reducing inappropriate hospital use, identified with diagnosis-independent and explicit criteria methods.
Material and methods: Systematic review of the literature to identify evaluative studies of interventions for reducing inappropriate hospìtal use, followed by a narrative synthesis of their characteristics and results. Works were included in English, French or Spanish languages, with experimental, quasi-experimental or observational designs, and with or without group control.
Results: We found 15 evaluative studies (2 randomised clinical trials, 8 quasi-experimental with control group and 5 with beforeafter without control group designs), the majority of them carried out in the United States (3 in Spain). The heterogeneity in hospital characteristics, hospitalisation units, patients characteristics, sampling unit, instruments, and presentation of results limited the quantitative synthesis. Feedback and administrative interventions were the most common. All the studies except 2 were positive, showing reductions in several outcomes (percentage of inappropriate stays, inappropriate admissions or inappropriate stays in the day previous to discharge, and in the length of stay). Intensive interventions that combined educational, feedback, self-assesment and administrative components showed the best results.
Conclusions: The literature review suggests that several interventions are effective to reduce inappropriate hospital use, particularly if they are direct, active, reach the doctors and combine several components.
Copyright © 2008 Sociedad Española de Calidad Asistencial. Published by Elsevier Espana. All rights reserved.