Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China

Jingjing Chang; Hongxia Gao; Dai Su; Haomiao Li; Yingchun Chen

doi:10.3389/fpubh.2023.1106499

Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China

Front Public Health. 2023 May 25:11:1106499. doi: 10.3389/fpubh.2023.1106499. eCollection 2023.

Authors

Jingjing Chang¹, Hongxia Gao^{2

3}, Dai Su⁴, Haomiao Li⁵, Yingchun Chen^{2

3}

Affiliations

¹ Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China.
⁴ School of Public Health, Capital Medical University, Beijing, China.
⁵ School of Political Science and Public Administration, Wuhan University, Wuhan, China.

Abstract

Objective: This 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.

Methods: Medical 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.

Results: Nearly 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).

Conclusions: Many 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.

Keywords: admission records; appropriateness evaluation protocol; inappropriate admissions; medical records; the change in appropriateness of admission.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

China / epidemiology
Hospitalization*
Hospitals, County*
Humans
Patients
Retrospective Studies

Grants and funding

This work was supported by the National Natural Science Foundation of China (Nos. 71473096 and 71673101). The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding authors had full access to all the data in the study and had the final responsibility for the decision to submit for publication.