THE PROSPECTIVE VERSION OF THE APPROPRIATENESS EVALUATION PROTOCOL (AEP) IN PORTUGAL: OUR FIRST EXPERIENCE Javier R. Vera, Nuno Vieira, Luisa Arez, Rui Tomé Department of Internal Medicine. Sector I. Hospital do Barlavento Algarvio Portimão. Portugal. EU
INTRODUCTION Appropriateness Evaluation Protocol (AEP).-Developed on the ´80s to evaluate the overuse ofhospital beds. -60 objective criteria. Classify as appropriate orinappropriate the admission and stay.-Appropriateness=1 criterion
Modalities of AEP (I)Depending on the kind of Dependending on thestudy: speciality:-Prospective -Medical Protocol-Concurrent -Surgical Protocol-Retrospective -Pediatric Protocol
Modalities of AEP (II)Complemented AEP : 1. Demographic parameters (age, gender) 2. Clinical parameters (multiadmission, mortality, comorbidity-Charlson) 3. Appropriateness AEP 4. Management parameters: Average stay,admission during the weekend, length of time from theadmission to the Emergency Department until theadmission to the Department of Internal Medicine
APROPRIATENESS EVALUATION PROTOCOL Utility • Numeric data. Makes possible comparing the efficiency of hospitals with similar characteristics. B) Causes of appropriateness/inappropriateness. Strategies to decrease inappropriateness
OBJECTIVEStudying on Medicine I: 1. Inappropriateness of admissions 2. Causes of appropriateness/inappropriateness
MATERIAL AND METHOD (I)Kind of study:Systematic randomized prospective studyInclusion criterion:Patients admitted on beds 9, 22, 23, 24 of Sector Iof the Department of Medicine during 2003.Exclusion criterion:Patients moved from other beds of the Department.
MATERIAL AND METHOD (II)Tool of assessment:Prospective medical complemented version of the AEP: 1. Demographic parameters (age, gender) 2. Clinical parameters (multiadmssion, mortality, comorbidity-Charlson) 3. Appropriateness AEP 4. Management data: average stay, admission during the weekend, time from the admission to the emergency department to the admission to the Department of Internal Medicine
MATERIAL AND METHOD (III)Statistical analysis:Access databaseAverage, CIΧ2, T StudentSPSS for Windows
RESULTS (II) Appropriateness AEP17,7% inappropriate admissions -diagnostic tests or therapies that could havebeen done as outpatient -Need admission, but not in an acute care hospital83,3% appropriate admissions -29,2% => 2 appropriateness criteria
RESULTS (III) Reasons for appropriateness140 96,5%120100 80 60 40 20 9,72% 6,94% 0 Inv Tech IV Med IM Ab Alts elect motor Def Act Hem Brad/taqu Alts cons
RESULTADOS (IV) Management parametersAverage stay: 8,44 days (Sector average 9,89)Admissions during the weekend: -N= 17 (9,7%) -Average stay: 13,29 dias (vs 7,92 in admissions Mon-Fry) -Mortality= 0
RESULTS (V) Management paramenters Procedence of the patientsoutpatients Other Dpts 5% 1% Emergency 94%
RESULTS (VI) Management parametersTime from the admission to the hospital until the admission in Medicine I 35,00% 30,00% 25,00% 20,00% 15,00% 10,00% 5,00% 0,00% <24h 24-48h 48-72h >72h
CONCLUSIONS (I)1.The inappropriateness of the admissions was 17,7%,result similar to those of other studies carried out inthe Iberian Peninsula.2. The most common criterion for appropriateness wasutilization of intravenous therapy. A carefulconsideration of the need of parenteral medicationmight eventually make the patients tributary of otherlevel of care than an acute care Hospital.
CONCLUSIONS (II)3. The longer stay of the people admitted during theweekend might be due to the inexistence of electivemedical care during that period. A specific program ofassistance to the ward on weekends might improvethis parameter.