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Effectiveness of a physician-oriented feedback intervention on inappropriate hospital stays
Pedro Antón1, Salvador Peiró, Jesús M Aranaz
1Fundación Instituto de Investigación en Servicios de Salud, San Vicente 112, 3, 46007 Valencia, Spain.
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.
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