Assessing the extent to which hospitals are used for acute care purposes.

Objectives: The degree to which Manitobans were appropriately hospitalized for medical conditions was assessed using a retrospective chart review of a sample of patients in 26 hospitals.

Research Design: A standardized set of object-based, nondiagnostic criteria (Inter-Qual) was used by trained abstractors to assess the patient at admission and for each day of stay.

Results: A high percentage of admissions and days of care were inappropriate. Overall, 49.5% of medical patients were acute at the time of admission, 1.6% required no health care services, and 48.9% could have received care through alternate methods or facilities. Only 33.4% of the subsequent days of stay were appropriate. For patients assessed as acute at the time of admission, by the 8th day of stay, only 47% were still acute and by day 30, only 27% were acute. Patients aged 75 years or older were just as likely to be acute at the time of admission as were younger patients; however, they accounted for 54% of the days in the study, and fewer than 30% of these days were acute. Our data suggest that despite their high use of hospitals, disadvantaged groups (the poor, aboriginal Manitobans), have the same levels of appropriateness as others.

Conclusions: We conclude that alternatives to hospital care must first be established and made known and available before a shift in health care resources can occur.