الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Hospital-based services are an expensive part of the healthcare system in Egypt. The high and rising cost of health care led hospital administrators to try to decrease the inappropriate use that occurs because of unnecessary admissions and prolonged length of stay because reducing the time that patients spent in hospitals is seen as one way of controlling health care costs(Kalant et al., 2000).
In a study conducted in the surgical wards of Ismailia General and University Hospitals Elias found that inappropriate days of care constituted 57.5% and 45% of total hospital days, respectively (Elias, 2001).
Nour El Din (1998), found in a study conducted in the general surgery departments in health insurance hospital and a private hospital in Alexandria the proportion of inappropriate admissions and inappropriate days of care were 24.4% and 50.5% respectively.
This variations in the attitude governing medical practice led to the development of the Utilization Review (UR) which is a component of the Utilization Management (UM).
The purpose of UM and UR is to both identify and resolve problems that cause inappropriate hospital utilization. There are three patterns of inappropriate hospital utilization: overutilization underutilization and misutilization (Brown, 2000).
The present study is concerned with the assessment of inappropriate admissions and inappropriate hospital days of care using the Appropriateness Evaluation Protocol(AEP) and to determine the possible causes of such inappropriate utilization at Cairo University Hospital Surgical Departments.
The study was a cross-sectional study that included a convenient sample of 350 patients. Patients were involved from four surgical departments in the Cairo University Hospital, namely:
1-General Surgery Department (29B).
2-General Surgery Department (28B).
3-Vascular Surgery Department (27B).
4-Vascular Surgery Department (30B), in addition to the ICU (intermediate and intensive care departments. The field work was conducted through a period of 4months. Follow up of all selected cases was performed three times to access the appropriateness of days of care till discharge in addition to the first visit.
Each patient was asked to complete a questionnaire including personal data, data about admission data about discharge and financial settlement.
The necessity of admission of the patient was assessed using the AEP. If any one of the criteria was fulfilled, the admission was classified as appropriate. If not, the reason of inappropriate admission was mentioned.
The hospital days of care were assessed concurrently (day by day) using the appropriateness evaluation protocol. If any one of the objective criteria items was fulfilled, the day was considered appropriate. If none was met with the day was considered inappropriate and the reason for hospital stay for that day was stated.