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Assessment of appropriateness of hospitalizations in Ukraine: analytical framework, method, and findings

Citation

Doroshenko, Olena et al. (2019), Assessment of appropriateness of hospitalizations in Ukraine: analytical framework, method, and findings, Dryad, Dataset, https://doi.org/10.5061/dryad.2v6wwpzh9

Abstract

Objectives: This article reviews the applicability of a customized version of the Appropriateness Evaluation Protocol (AEP) to evaluate the magnitude of inappropriate hospitalizations in two regions of Ukraine.

Data and methods: The original AEP was modified to develop a customized tool, which included criteria for the appropriateness of hospitalization and duration of inpatient stay. The customization of the tool followed the Delphi procedure. We randomly selected 381 medical records to test the feasibility and reliability of the method and 800 medical records to evaluate the scope of inappropriate hospitalizations. We used descriptive and analytical statistics, ROC analysis, and Cohen's kappa to check the consistency between the findings of primary reviewers and experts.

Result: We observed high levels of agreement in conclusions of primary reviewers (reference standard) and experts during testing of the reliability and validity of the method. The external validity check showed that the use of the tool by different experts provided high accuracy: 95.1 sensitivity, 76.6 specificity, and AUC=0.948 (р<0.001) for analysis of the appropriateness of admissions; 95.3 sensitivity, 84.7 specificity, and AUC=0.900 (р=0.001) for the duration of hospitalizations. Cohen's kappa coefficient (κ) indicated agreement in expert evaluations of 0.915 (95% СІ 0.799 to 1.000) and 0.812 (95% СІ 0.749 to 0.875), respectively.

We found that over one-third of admissions (38.1%; 95% СІ 33.9 to 43.5) and over half of total bed-days were unnecessary (57.4%; 95% СІ 56.4 to 58.5). The highest levels of stay were observed in hospitals’ general medicine departments (64.6%; 95% СІ 63.0 to 66.3) compared to other departments included in the analysis.

Conclusion: The proposed method is robust in assessing the appropriateness of hospitalizations and duration of inpatient stays. The quantified levels of unnecessary hospital care indicate the need for improving efficiency and quality of care and optimizing the excessive hospital capacities in Ukraine.

Methods

The original AEP was modified to develop a customized tool, which included criteria for the appropriateness of hospitalization and duration of inpatient stay. The customization of the tool followed the Delphi procedure. We randomly selected 381 medical records to test the feasibility and reliability of the method and 800 medical records to evaluate the scope of inappropriate hospitalizations. We used descriptive and analytical statistics, ROC analysis, and Cohen's kappa to check the consistency between the findings of primary reviewers and experts.

Usage Notes

In addition to the dataset, we included the table with the description of variables, and the questionnaires used for data collection

Funding

The study was supported by the World Bank (within Improving effectiveness in human development and social accountability Project financed by the Department for International Development).