Evaluation of quality improvement interventions to reduce inappropriate hospital use.

OBJECTIVE: To assess the impact of process analyses and modifications on inappropriate hospital use. DESIGN: Pre-post comparison of inappropriate hospital use after process modifications. SETTING: The Department of Internal Medicine of the Geneva University Hospitals, Switzerland. PARTICIPANTS: A random sample of 498 patients. INTERVENTIONS: Two processes of care (i.e. non-urgent admissions and transfer to a rehabilitation hospital), which influenced inappropriate hospital use, were identified and modified. The impact of these modifications was then assessed. Main Outcome Measures: The proportion of inappropriate hospital admissions and inappropriate hospital days. RESULTS: As a baseline assessment before quality improvement interventions, the appropriateness of hospital use (admissions and hospital days) was evaluated using the Appropriateness Evaluation Protocol (AEP) in a sample of 500 patients (5665 days). After modification of the two processes through a quality improvement program, inappropriate hospital use was reassessed in a sample of 498 patients (6095 days). Inappropriate hospital admissions decreased from 15 to 9% (P = 0.002) and inappropriate hospital days from 28 to 25% (P = 0.12). CONCLUSION: Using the AEP as a criterion, the quality improvement interventions significantly reduced inappropriate hospital use due to the process of non-urgent admissions, but the reduction of inappropriate hospital days specifically attributed to the transfer to the rehabilitation hospital did not reach statistical significance.