Assessing the causes inducing lengthening of hospital stays by means of the Appropriateness Evaluation Protocol.
Fontaine, Pierre ; Jacques, Jessica ; Gillain, Daniel et al
in Health Policy (2011)
OBJECTIVES: The objective is to evaluate the use of the Appropriateness Evaluation Protocol (AEP) as a screening tool for determining the causes of the non-justified days to help hospitals to decrease the ... [more ▼]
OBJECTIVES: The objective is to evaluate the use of the Appropriateness Evaluation Protocol (AEP) as a screening tool for determining the causes of the non-justified days to help hospitals to decrease the length of stay while preserving the quality of care. METHODS: Three successive cross-sectional surveys were conducted from 2003 till 2005, in 23 Belgian hospitals. During this period, 10921 days were audited by means of the AEP. This study is focused on adult acute non-intensive care units. The appropriateness of each day of the sample was assessed, and for those considered as inappropriate, the reasons explaining the prolongation of the stay were investigated. RESULTS: The proportion of inappropriate days was 24.61%. There is a high variability across specialties and hospitals. Regarding inappropriate days, the analysis of causes of prolongation, globally, by bed index or by hospital, indicated clearly internal and external factors that lengthen stays. The most frequent reasons are waits for an examination (22%) and the lack of extra-hospital structures (31%). CONCLUSIONS: The use of AEP as a tool of internal audit to measure the proportion of non-justified days and their causes turns out to be possible and the obtained results has provided some accurate and useful information for the participating, and allowed them to take concrete decisions which lead to shrinking of the length of hospital stay. [less ▲]Detailed reference viewed: 45 (14 ULg)
The clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients.
Hiligsmann, Mickaël ; Rabenda, Véronique ; Bruyère, Olivier et al
in Health Policy (2010), 96
OBJECTIVES: This study aims to estimate the clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients and the potential cost-effectiveness of adherence-enhancing ... [more ▼]
OBJECTIVES: This study aims to estimate the clinical and economic burden of non-adherence with oral bisphosphonates in osteoporotic patients and the potential cost-effectiveness of adherence-enhancing interventions. METHODS: A validated Markov microsimulation model estimated costs and outcomes (i.e. the number of fractures and the quality-adjusted life-year (QALY)) for three adherence scenarios: no treatment, real-world adherence and full adherence over 3 years. The real-world adherence scenario employed data from a published observational study. The incremental cost per QALY gained was estimated and compared across the three adherence scenarios. RESULTS: The number of fractures prevented and the QALY gain obtained at real-world adherence levels represented only 38.2% and 40.7% of those expected with full adherence, respectively. The cost per QALY gained of real-world adherence compared with no treatment was estimated at euro10279, and full adherence was found to be cost-saving compared with real-world adherence. CONCLUSIONS: This study suggests that more than half of the potential clinical benefits from oral bisphosphonates in patients with osteoporosis are lost due to poor adherence with treatment. Depending on their cost, interventions with improved adherence to therapy have the potential to be an attractive use of resources. [less ▲]Detailed reference viewed: 60 (12 ULg)