Effectiveness of feedback to physicians in reducing inappropriate use of hospitalization: a study in a Spanish hospital

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Abstract
Objectives. To evaluate the effectiveness of feedback to medical staff in reducing inappropriate hospital days, particularly those attributable to conservative medical discharge policies. Design. Quasi-experimental pre-test/post-test with non-equivalent control group. Setting. A publicly funded hospital in industrial belt in Barcelona (Spain), serving a predominantly urban population of 100 000. Study participants. Two non-equivalent groups: control group (surgery department) and intervention group (internal medicine department). Intervention. Meetings between hospital management and medical staff of the intervention group to inform clinicians of percentages and reasons for inappropriate stays in their departments. Main outcome measures. Total inappropriate hospital days and percentage attributable to physicians, measured with the Appropriateness Evaluation Protocol before, during, and after intervention. Results. There were no relevant differences in the characteristics of the populations whose stays were reviewed during each of the periods. The total number of inappropriate stays and the percentage attributable to the doctor in the control group did not show any differences between the periods. In the intervention group, inappropriate stays attributable to the doctor decreased from 35.9% in the period prior to intervention to 27.7% during intervention (relative drop of 22.8%; P < 0.01), and rose to 32.7% after intervention. Differences in total inappropriate days were not significant. Conclusions. Providing physicians with feedback about percentages of inappropriate hospital days produced a significant reduction in the number of inappropriate stays attributable to the doctor, although the impact on overall inappropriate stays is inconclusive.

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