Identifying and acting on potentially inappropriate care.

Area of Science:

• Health Services Research
• Patient Safety
• Clinical Quality Measurement

Background:

• Potentially inappropriate care represents treatments lacking clinical evidence.
• Measuring and reducing such care is crucial for improving hospital quality.
• Variability in care practices highlights opportunities for quality improvement initiatives.

Purpose of the Study:

• To develop and apply a model for measuring potentially inappropriate care in Australian hospitals.
• To identify hospital-specific rates of "do-not-do" procedures.

Main Methods:

• Secondary analysis of national hospital discharge data (2010-11).
• Focused on diagnosis-procedure pairs identified as inappropriate in existing literature.
• Calculated hospital-specific incidence rates for selected procedures.

Main Results:

• Five "do-not-do" procedures occurred over 100 times weekly on average.
• Hyperbaric oxygen therapy was the most frequent inappropriate treatment (4659 admissions).
• Significant variation in "do-not-do" procedure rates existed between hospitals, even for similar patient groups.

Conclusions:

• Hospital-specific rates of "do-not-do" treatments demonstrate substantial variation.
• Informing hospitals of their performance relative to peers is recommended.
• Hospitals with persistently high rates of inappropriate care require external clinical peer review.