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Open AccessArticle

Determinants of Inappropriate Admissions in County Hospitals in Rural China: A Cross-Sectional Study

by Yan Zhang 1,2, Liang Zhang 1,2, Haomiao Li 1,2 and Yingchun Chen 1,2,*
1
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
2
Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430030, China
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(6), 1050; https://doi.org/10.3390/ijerph15061050
Received: 12 March 2018 / Revised: 15 May 2018 / Accepted: 21 May 2018 / Published: 23 May 2018
(This article belongs to the Section Health Economics)
Inappropriate admissions have contributed to the rapid increase in hospitalisations in rural China. This study characterised the degree and determinants of inappropriate admissions in county hospitals. We used expert consultation to develop an appropriateness evaluation protocol that included nine requirements for services and 21 indicators of disease severity. A total of 2230 medical records from 2014 were collected from five county hospitals by stratified cluster sampling and evaluated for appropriateness using the protocol in 2016. The determinants of inappropriate admissions were analysed by two-level logistic regression. The overall inappropriate admission rate was 15.2%. Patients aged <20 years (19.3%), patients in the paediatrics department (22.9%), patients with lower disease severity (22.3%), and patients without complications (17.0%) were more likely to have been inappropriately admitted than other groups. Age, treating department, disease severity, causes of hospitalisation, complications, and length of stay were determinants of inappropriate admission. Policymakers must act to reduce the high prevalence of inappropriate admissions in county hospitals in rural China, by guiding patients to seek primary care and changing the motivating mechanism of these hospitals. View Full-Text
Keywords: New Rural Cooperative Medical System; inappropriate admission; county hospital; appropriateness evaluation protocol; rural China New Rural Cooperative Medical System; inappropriate admission; county hospital; appropriateness evaluation protocol; rural China
MDPI and ACS Style

Zhang, Y.; Zhang, L.; Li, H.; Chen, Y. Determinants of Inappropriate Admissions in County Hospitals in Rural China: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2018, 15, 1050.

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