Inappropriate hospital care and severity of illness: results from a nationwide study

Little is known about the clinical characteristics of hospital patients who do not meet standard utilization review criteria for acute care settings. This study examined whether patients with either inappropriate hospital admissions or days of care were less severely ill on a number of indicators compared to those designated as appropriate by a widely used utilization review instrument. Using data from a probability sample of 6063 medical and surgical hospitalizations at 50 Department of Veterans Affairs medical centers, we found strong associations between the appropriateness of admissions and days of care and four indicators of severity of illness. These results suggest that utilization management programs and preadmission screening probably successfully screen out less severely ill patients who have less need of hospital-level services.