July 14, 1997

Risk Factors for a Medically Inappropriate Admission to a Department of Internal Medicine

Author Affiliations

From the Institute of Social and Preventive Medicine, University of Geneva (Dr Perneger), and the Department of Internal Medicine, Geneva University Hospitals (Drs Chopard, Sarasin, Gaspoz, Lovis, Unger, Junod, and Waldvogel), Geneva, Switzerland.

Arch Intern Med. 1997;157(13):1495-1500. doi:10.1001/archinte.1997.00440340139014

Objective:  To identify patient- and admission-related risk factors for a medically inappropriate admission to a department of internal medicine.

Methods:  Cross-sectional study of a systematic sample of 500 admissions to the department of internal medicine of an urban teaching hospital. The appropriateness of each admission and reasons for inappropriate admissions were assessed using the Appropriateness Evaluation Protocol. Risk factors included the time (day of week and holidays) and manner (through emergency department or direct admission) of admission, patient age and sex, health status of patient and spouse, living arrangements, formal home care services, and informal support from family or friends.

Results:  Overall, 76 (15.2%) hospital admissions were rated as medically inappropriate by the Appropriateness Evaluation Protocol. In multivariate analysis, the likelihood of an inappropriate admission was increased by better physical functioning of the patient (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.1 [for 1 SD in Physical Functioning scores]), lower mental health status of the patient's spouse (OR, 2.6; 95% CI, 1.3-5.6), receipt of informal help from family or friends (OR, 3.3; 95% CI, 1.5-7.2), and hospitalization by one's physician (OR, 3.6; 95% CI, 1.7-7.5). Receiving formal adult home care was not associated with inappropriateness of hospitalization.

Conclusions:  Inappropriate admissions to internal medicine wards are determined by a mix of factors, including the patient's health and social environment. In addition, the private practitioners' discretionary ability to hospitalize their patients directly may also favor medically inappropriate admissions.Arch Intern Med. 1997;157:1495-1500