[Evaluation of the appropriateness of public hospital use using AEP, Disease Staging, and other DRG-based criteria (essential levels of care--Italian LEA): results and degree of agreement among the different methodologies]

Currently, more than one instrument has been found to be reliable and valid for the assessment of hospital admission appropriateness. However; data on the level of agreement among these methodologies are extremely scarce. The study was aimed at evaluating whether the percentages of organizational (in)appropriateness resulting from some of the most diffused instruments (Italian Appropriateness Evaluation Protocol--AEP/PRUO; Disease Staging; Essential Levels of Care--LEA, version 2001 and 2008) are substantially concordant, or they largely depend upon the methodology. For each public hospital of Abruzzo, Italy, the amount of inappropriateness has been computed using six indicators: inappropriate days of care (PRUO1); totally inappropriate admissions (PRU02); early admissions DRGs according to the first Law on Italian LEA (LEA01); admissions assigned to one of the 108 potentially inappropriate DRGs according to the second Law on Italian LEA, currently inactive (LEA08). The sample was composed by all ordinary admissions made in 2006 in the Region, with the exception of PRUO indicators, which were based upon the manual revision of 2% of all admissions that could be assessed using PRUO methodology. We found a good correlation among most indicators based upon administrative discharge data (DS1, DS2 and LEA01), whereas the results obtained using PRUO and new LEA (LEA08) were discordant, and marked differences were observed also between the two PRUO indicators. Although the limitations of the study permit only preliminary conclusions, in future appropriateness evaluations it may be reasonable to use more than one indicator--allowing the creation of combined scores--and rank hospitals in large categories--avoiding excessively precise scores--as such rankings might relevantly differ depending upon the used instrument.

[Different use/abuse patterns (overweight/obesity, alcohol, smoking, drugs, cannabis, opiates, cocaine) according to job category. Results of a survey on 4024 young workers from Abruzzo, Italy: the Valentino Study]

Using a multidisciplinary questionnaire containing items from previously validated instruments (i.e. CAGE), during the year 2007 a survey (Valentino Project) was carried out on 4024 young workers (18-35 y) from Abruzzo, Italy to investigate the prevalence of use/abuse of alcohol, food, smoking, and drugs in different types of job categories, and to evaluate the potential association between occupational class and type of use/abuse. With the exception of cannabis use/abuse (13.5%), the prevalence of incorrect behaviours was higher than the young-adult general population (workers and non-workers) from Central-South Italy: overweight/obesity = 30.8%; current smoking = 45.7%; alcohol addiction = 17.3%; use/abuse of psychotropic legal drugs = 4.7%; cocaine = 4.5%; opiates = 1.0%; > 1 illegal drug (multiple abuse) = 3.9%. This negative scenario is accentuated by a probable > or = 25% underestimation of illegal drug use/abuse, and because drug use/abuse is inversely associated with age. Using logistic regression analyses (controlling for age, gender marital status, education, job-strain, self-reported health, and all other types of use/abuse), a significant independent association was found for the first time between specific types of use/abuse and some job categories (i.e. cocaine for traders/consultants; legal psychoactive drugs and cannabis for unqualified professions such as itinerants or precarious workers; smoking for Call-Center operators; overweight/obesity for farmers/artisans). These findings should be used to maximize the efficacy of substance use/abuse preventive strategies, which could be more precisely targeted to different professions, and raise the need to control for job category in future multivariate analyses investigating substance use/abuse predictors.

[Evaluation of the appropriateness of public hospital use using AEP in the Abruzzo Region of Italy: results by hospital and ward, main predictors and potential implications]

In the context of a wide healthcare system reorganization, the Abruzzo Region of Italy used the Appropriateness Evaluation Protocol (AEP) to carry out a systematic evaluation of the appropriateness of the admissions performed during 2006 in all public hospitals. After specific training courses, a sample representative of all ordinary admissions was assessed twice: first by regional investigators (external assessment) then by the local personnel (internal assessment). Random-effect logistic regression was used to evaluate potential inappropriateness predictors. On a total of 13081 hospital days (2393 hospitalizations), 39.7% (95% Confidence interval: 38.9%-40.6%) were inappropriate at the regional assessment; 39.5% at the internal assessment, with high correlation between the two controls (K = 0.73). Another 10.4% of admissions, excluded by the evaluation, was assigned to DRGs at high risk of inappropriateness and should be considered. In single hospitals, the inappropriateness ranged between 17.9% and 57.9%, with large variation across wards. Additional significant predictors of inappropriateness were the day and hour of admission and hospital size, with lower inappropriateness in bigger ones. In 2006, there was a large degree of hospital misuse in public hospitals in the Abruzzo Region. The approach used in the survey may have contributed to the drastic reduction of the number of ordinary admissions observed in the Region between 2006 and 2007.