Morteza Arab-Zozani1, Mohammad Zakaria Pezeshki2, Rahim Khodayari-Zarnaq3, Ali Janati4. 1. Department of Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran; Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran. 2. Department of Community and Family Medicine, Social Determinants of Health Research Center, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran. 3. Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. 4. Department of Health Services Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran. Electronic address: janatiali82@gmail.com.
Abstract
BACKGROUND: Inappropriate admission and hospitalization are types of overuse that impose a financial burden on all health systems, especially in hospitals. OBJECTIVE: To analyze the evidence on the inappropriateness of admission and hospitalization in Iranian hospitals. METHODS: This study was conducted using PubMed, Embase, Scopus, and Web of Science, as well as Persian databases, including Magiran and Scientific Information Database up to May 2018. Two researchers extracted result of the included studies, independently. We used Cohen's κ statistic for measuring inter-rater agreement. The meta-analyses were conducted based on pooled effect estimates for the rate of admission and hospitalization using the DerSimonian-Laird random-effects model with 95% confidence intervals (CI). RESULTS: Seventeen articles met the inclusion criteria. The inter-rater agreement was very good for abstracts and full-texts screening (κ 0.86 and 98, respectively). The overall inappropriate rate was 12.3% (95% CI, 8.4-17.5) and 11.9% (95% CI, 7.7-18.1) for admission and hospitalization, respectively. The inappropriate rate of admission was significantly higher before the Health Sector Evolution Plan (HSEP) than after HSEP (14.6%, 95% CI, 8.6-23.6 before HSEP and 10%, 95% CI, 5.5-17.3 after HSEP), and the inappropriate rate of hospitalization was significantly higher after HSEP than before HESP (9.5%, 95% CI, 5.2-16.7 before HSEP and 16.9%, 95% CI, 8.2-31.7 after HSEP). CONCLUSIONS: Adoption standard measures of admission and hospitalization, treating patients in appropriate care centers, and establishing a referral system is essential to reduce the inappropriate admission and hospitalization in Iranian hospitals. Such interventions can lead to a reduction in personnel costs and workload and ultimately increase the productivity of the hospital.
BACKGROUND: Inappropriate admission and hospitalization are types of overuse that impose a financial burden on all health systems, especially in hospitals. OBJECTIVE: To analyze the evidence on the inappropriateness of admission and hospitalization in Iranian hospitals. METHODS: This study was conducted using PubMed, Embase, Scopus, and Web of Science, as well as Persian databases, including Magiran and Scientific Information Database up to May 2018. Two researchers extracted result of the included studies, independently. We used Cohen's κ statistic for measuring inter-rater agreement. The meta-analyses were conducted based on pooled effect estimates for the rate of admission and hospitalization using the DerSimonian-Laird random-effects model with 95% confidence intervals (CI). RESULTS: Seventeen articles met the inclusion criteria. The inter-rater agreement was very good for abstracts and full-texts screening (κ 0.86 and 98, respectively). The overall inappropriate rate was 12.3% (95% CI, 8.4-17.5) and 11.9% (95% CI, 7.7-18.1) for admission and hospitalization, respectively. The inappropriate rate of admission was significantly higher before the Health Sector Evolution Plan (HSEP) than after HSEP (14.6%, 95% CI, 8.6-23.6 before HSEP and 10%, 95% CI, 5.5-17.3 after HSEP), and the inappropriate rate of hospitalization was significantly higher after HSEP than before HESP (9.5%, 95% CI, 5.2-16.7 before HSEP and 16.9%, 95% CI, 8.2-31.7 after HSEP). CONCLUSIONS: Adoption standard measures of admission and hospitalization, treating patients in appropriate care centers, and establishing a referral system is essential to reduce the inappropriate admission and hospitalization in Iranian hospitals. Such interventions can lead to a reduction in personnel costs and workload and ultimately increase the productivity of the hospital.