They then linked these results with hospital utilization data to determine the appropriateness of hospital stays for adult medical patients. Finally, they identified which patient groups were likely to be treated in hospital. DeCoster and colleagues suggest that audit activities focus on certain categories of patients, i.e., those with stays longer than 1 week, those with nervous system, circulatory, respiratory or digestive diagnoses, elderly patients and those not admitted through the emergency department. They conclude that better targeting of utilization review could ultimately improve the allocation of health care resources. There are limitations to the approach proposed.
Several questions remain unanswered.
This study was undertaken by an experienced and internationally respected team of health services researchers with stable government funding. That a small general hospital could undertake equivalent analyses in a timely and relevant fashion seems unlikely. Those of us who have worked with hospital utilization data do not underestimate the technical problems in producing meaningful and useful results. And that is only the beginning. The real challenge is to communicate those results to the people who decide which patients should be treated in hospital.