[Misuse of inpatient care--background, indicators and evaluation parameters]

17a of the German hospital financing law constitutes the basis for the evaluation of not justified hospital admission. It demands not to admit patients into hospital who do not need inpatient treatment or, treat them in an inpatient-setting longer than medical required. Unjustified inpatient treatment results from faulty decision with regard to admission, to adequate intensity of medical care or duration of stay. The priority of outpatient treatment over the pre-, post-, partial and complete inpatient treatment must be taken into consideration at each decision. The following items can indicate unjustified inpatient treatment already prior to the detailed examination of a hospital; length of stay higher than average, a lot of patients staying only a short time, high rate of self-admission, long preoperative period, inadequate relations between age and diagnosis groups, increasing frequency of unspecified symptoms and syndromes in the main treatment diagnosis, peculiarities concerning the categorisation of nursing care etc. The systematic approach to the analysis of unjustified hospital admission requires the evaluation of clinical pictures with the question as to the primary necessity of inpatient treatment, the adequate length of stay and whether there are alternatives of medical care as an outpatient. Testing parameters are, among others, occasion of admission, severity of illness, indication for complete in-patient treatment, utilisation of alternatives to medical care (outpatient, pre-, post-, partial inpatient treatment), adequacy of diagnostic or therapeutic intervention with regard to the disease, intensity, respectively chronological sequence of medical procedures, efficiency of organizational processes, transfer or discharge in time. The evaluation of unjustified admission to inpatient treatment should be conducted with a systematic approach including standardised methods and an adequate sample size on the basis of the individual medical report. In 1995 an outline as to testing of unjustified hospital admission as already presented by Bundes-Arbeltsgemeinschaft der Medizinischen Dienste der Krankenversicherung.