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Research ArticleFamily Practice and the Health Care System

Appropriateness Of Hospital Use By Family Physicians

Robert A. Fried, Deborah S. Main and B. Ned Calonge
The Journal of the American Board of Family Practice May 1994, 7 (3) 229-235; DOI: https://doi.org/10.3122/jabfm.7.3.229
Robert A. Fried
From the Department of Family Medicine, University of Colorado School of Medicine, Denver. Address reprint requests to Robert A. Fried, MD, Department of Family Practice, Maine Medical Center 31 Bramhall Street, Portland, ME 04102
MD
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Deborah S. Main
From the Department of Family Medicine, University of Colorado School of Medicine, Denver. Address reprint requests to Robert A. Fried, MD, Department of Family Practice, Maine Medical Center 31 Bramhall Street, Portland, ME 04102
PhD
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B. Ned Calonge
From the Department of Family Medicine, University of Colorado School of Medicine, Denver. Address reprint requests to Robert A. Fried, MD, Department of Family Practice, Maine Medical Center 31 Bramhall Street, Portland, ME 04102
MD, MPH
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Abstract

Background: Reducing inappropriate hospital admissions could lead to lower total health care costs Without compromising the quality of care. Research suggests that a sizeable portion of hospital admissions are inappropriate. Other studies indicate that family physicians use health care resources, including hospitalizations, less often than other primary care physicians. To gain additional insight into family physicians' decisions to admit patients, we performed an exploratory study using the Appropriateness Evaluation Protocol, a validated, clinically based utilization review instrument.

Methods: We assessed admissions by community-based and residency-based family physicians to a single university-affiliated hospital during calendar year 1988. A total of 90S patients were admitted to the hospital by family physicians during the study period. Of these, 889 records had complete data. Each was reviewed for appropriateness of admission. We calculated percentages of inappropriate admissions and used logistic regression to ascertain variables that were significant predictors of inappropriateness.

Results: Overall, 5.4 percent of admissions were categorized as inappropriate. Omitting obstetric cases, the rate was 10.5 percent. Inappropriate admissions did not cluster around a small number of diagnoses or diagnosis-related groups. Using logistic regression, we found that urgency of admission, patient insurance status, and residency-based physician admission versus community-based physician admission were significant predictors of inappropriate hospital use. Of the inappropriate admissions, 70 percent were so rated because diagnostic procedures or treatments could have been performed on an outpatient basis.

Conclusions: In contrast with other studies for which physician specialty was not controlled, family physicians less frequently admitted patients inappropriately. Predictors of inappropriateness differed from those found in other studies. Changes in hospital systems, in addition to educational efforts directed toward individual physicians, hold promise as a strategy for reducing inappropriate hospital use.

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The Journal of the American Board of Family     Practice: 7 (3)
The Journal of the American Board of Family Practice
Vol. 7, Issue 3
1 May 1994
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Appropriateness Of Hospital Use By Family Physicians
Robert A. Fried, Deborah S. Main, B. Ned Calonge
The Journal of the American Board of Family Practice May 1994, 7 (3) 229-235; DOI: 10.3122/jabfm.7.3.229

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Appropriateness Of Hospital Use By Family Physicians
Robert A. Fried, Deborah S. Main, B. Ned Calonge
The Journal of the American Board of Family Practice May 1994, 7 (3) 229-235; DOI: 10.3122/jabfm.7.3.229
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