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Identifying and acting on potentially inappropriate care
Author(s) -
Duckett Stephen J,
Breadon Peter,
Romanes Danielle
Publication year - 2015
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja15.00025
Subject(s) - medicine , emergency medicine , hospital discharge , incidence (geometry) , intensive care medicine , physical therapy , optics , physics
Objective: To develop a model to measure potentially inappropriate care in Australian hospitals. Design: Secondary analysis of computerised hospital discharge data for all Australian hospitals for the 2010–11 financial year. Main outcome measure: Hospital‐specific incidence of selected diagnosis–procedure pairs identified as inappropriate in other literature. Results: Five hospital procedures that are not supported by clinical evidence happened more than 100 times a week, on average. The most frequent of these do‐not‐do treatments was hyperbaric oxygen therapy for a range of specific conditions (4659 admissions in 2010–11). The rate of do‐not‐do procedures varied greatly, even among comparator hospitals that provided the procedure and that treated the relevant patient group. Among comparator hospitals, an average of 3.3% of patients with osteoarthritis of the knee received arthroscopic lavage and debridement of the knee (a do‐not‐do treatment), but four hospitals had rates of over 20%. There was also great variation in hospital‐specific rates of procedures that should not be done routinely. Conclusion: Hospital‐specific rates of do‐not‐do treatments vary greatly. Hospitals should be informed about their relative performance. Hospitals that have sustained, high rates of do‐not‐do treatments should be subject to external clinical review by expert peers.