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Prevalence and determinants of inappropriate admission and hospitalization in Iran: A systematic review and
Seyyed Mostafa Kouhestan1, Reza Hashempour1, Behzad Raei1
1Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Inappropriate hospital admissions and hospitalizations are common, affecting 11% and 13% of cases, respectively. Physician behavior is a key factor, highlighting the need for increased monitoring to improve healthcare resource allocation.
Area of Science:
- Health Services Research
- Medical Economics
- Quality Improvement
Background:
- Hospital services represent a significant portion of healthcare expenditure.
- Efficient resource utilization is crucial for sustainable healthcare systems.
- Previous studies have quantified inappropriate hospital admissions and hospitalizations, necessitating a systematic review.
Purpose of the Study:
- To systematically review existing literature on inappropriate hospital admissions and hospitalizations.
- To determine the pooled prevalence of inappropriate hospital services.
- To identify the primary reasons contributing to inappropriate hospital utilization.
Main Methods:
- A comprehensive search of multiple databases (PubMed, Scopus, Web of Science, Google Scholar, Sid, Magiran, Barkat) and grey literature was conducted in January 2018.
- Studies assessing the appropriateness of hospital services were included, with quality appraisal using the Newcastle-Ottawa scale.
- Meta-analysis techniques including I2 test, subgroup analysis, metaregression, and sensitivity analysis were performed using STATA.
Main Results:
- Fifteen studies, analyzing 1576 initially identified records, met the inclusion criteria.
- The pooled prevalence of inappropriate admissions was 11% (95% CI: 8%-14%), and inappropriate hospitalizations were 13% (95% CI: 10%-16%).
- Physician-related factors were identified as the most significant determinants of inappropriate hospitalizations.
Conclusions:
- A substantial proportion of healthcare services provided in hospitals are inappropriate.
- Increased monitoring of physicians is recommended to reduce the incidence of inappropriate healthcare delivery.
- Addressing physician-driven factors can lead to more efficient and appropriate use of hospital resources.
Abstract:
Background: A huge portion of health expenditure is attributed to hospital services. Thus, it is important to use the resources appropriately. Many studies have measured inappropriate admissions and hospitalizations. The aim of this study was to review them systematically and determine the pooled quantity as well as the reasons behind such admissions and hospitalizations. Methods: PubMed, Scopus, Web of Science, Google scholar, and internal databases such as Sid, Magiran, and Barkat were searched in January 2018. Moreover, the grey literature was also performed. All studies which had assessed the appropriateness and inappropriateness of services were included. Newcastle-Ottawa scale was used for quality appraisal. I2 test, subgroup analysis, metaregression, and sensitivity analysis were performed. STATA was used for analysis. There was neither time limitation nor language limitation. The registration number in PROSPERO is CRD42019123401. Results: Of 1576 studies, 15 met the inclusion criteria. The number of medical files ranged from 198 to 1815. Most of the studies (14) were performed in teaching hospitals. AEP was the most frequent tool for assessing inappropriateness of the services. The pooled inappropriate admission and hospitalization were 11% (95% CI= 8% - 14%)) and 13 % (95% CI= 10%-16%)), respectively. The most important determinants for inappropriate hospitalizations were attributed to physicians. Conclusion: A huge portion of health care services is inappropriate. Thus, it is highly recommended to monitor physicians more than before, as the more they are monitored, the less inappropriate the delivered services will be.
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