Acute hospital care is the most expensive form of medical care. Some of patients hospitalized in acute hospitals could be cared for in alternative settings without compromising quality of care. The Appropriateness Evaluation Protocol (AEP) is the most widely used tool for evaluation of appropriateness of hospitalisation in acute care hospitals. We applied AEP to 189 patients admitted within 20 days to department of surgery of a teaching hospital. We have evaluated appropriateness of admission and each following day of stay up till discharge or 15th day of hospitalization. Reasons of inappropriate admissions and delayed discharges were classified and analyzed. Results of the evaluation of selected patients were subject to control by a committee of fully specialized hospital physicians. 16 (8%) of 189 admissions and 306 (27.5%) of 1114 evaluated days of stay failed the AEP criteria. These patients could be well served by lower treatment intensity in outpatient clinics, nursery homes or their own homes. Such a shift in pattern of provided care requires profound organizational changes many of which are out of reach of individual acute hospitals. Despite some limitations we find AEP a useful tool for internal utilization review. External application of AEP in a representative sample of acute care hospitals could provide important data for future development of the Czech health care system.

Ustav verejného zdravotnictví a preventivního lékarství 2 LF UK Praha

Primary health care in the Czech Republic: brief history and current issues