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Design and development of a utilization review program in Portugal
M Bentes1, M L Gonsalves, M Santos
1Departamento de Desenvolvimento de Sistemas de Financiamento e de Gestão, Instituto de Gestão Informática e Financeira da Saúde, Lisbon, Portugal.
Summary
Portuguese hospitals found that nearly 25% of non-obstetric admissions and 50% of inpatient days were inappropriate. Most inappropriate days involved patients ready for discharge, highlighting areas for healthcare efficiency improvements.
Area of Science:
- Health Services Research
- Hospital Management
- Quality Improvement in Healthcare
Background:
- The Portuguese government hospital sector sought to improve healthcare efficiency and resource allocation.
- The original Appropriateness Evaluation Protocol (AEP) required adaptation for effective implementation in the national context.
Purpose of the Study:
- To describe the adaptation and implementation of the Appropriateness Evaluation Protocol (AEP) in Portuguese public hospitals.
- To identify and quantify inefficiencies in hospital admissions and patient stays using the modified AEP.
- To assess the impact of the modified AEP on healthcare resource utilization.
Main Methods:
- Adaptation of the original AEP through pilot hospital experiments.
- Conducting reliability and user profile studies on the modified criteria.
- Analyzing inpatient databases and performing targeted patient reviews.
- Integration with an output-based funding system.
Main Results:
- Approximately 25% of non-obstetric admissions were deemed inappropriate.
- An average of 50% of inpatient days were identified as inappropriate.
- Seventy-five percent of inappropriate days were associated with patients ready for discharge.
- The modified AEP proved valuable in identifying and quantifying healthcare system problems.
Conclusions:
- The adapted AEP is a valuable tool for identifying and quantifying inefficiencies in hospital care.
- Significant opportunities exist for improving hospital resource utilization, particularly concerning discharge processes.
- The findings support the continued expansion and enhancement of the modified AEP in Portuguese hospitals.
- Integration with funding systems can further leverage AEP data for quality improvement.