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Biomedical subjects

Thomas V Perneger

Publications and source records attributed to Thomas V Perneger.

At least 55 records · Page 3Linked to original sources

What smokers believe about light and ultralight cigarettes.

OBJECTIVES: To assess the knowledge of smokers and ex-smokers about light cigarettes and nicotine yields and their perception of the risk of lung cancer, and to identify the characteristics of smokers of light cigarettes. METHODS: Mail survey in a population sample of 494 smokers and exsmokers in Geneva, Switzerland, in 1999. RESULTS: Participants were on average 40 years old, and 49% were men. They estimated that one would have to smoke two light cigarettes or four ultralight cigarettes in order to inhale the same amount of nicotine as that in one regular cigarette. Most participants (60%) answered that the risk of lung cancer was the same, but 27% answered that this risk was lower in smokers of light cigarettes than in smokers of regular cigarettes. The most frequent answer (41% of answers) to an open-ended question on the meaning of the number of milligrams of nicotine printed on cigarette packs was that this number indicated the nicotine content in cigarettes, rather than a machine-determined yield in smoke. In a multivariate model, smoking mild, light, or ultralight (vs regular) cigarettes was associated with females, a lower Fagerström dependence score, an intention to quit smoking, and an intention to decrease cigarette consumption. CONCLUSIONS: Many smokers choose light cigarettes because they think that such cigarettes are safer or less addictive. The public should be further informed of the meaning and purpose of cigarette labels.

Adolescent↗

Hospitalisation process seen by patients and health care professionals.

Appropriate use of hospitalisation is an important concern in most countries. Previous studies have relied on professional opinion regarding the appropriateness of hospital stays, neglecting the patients' point of view. The purpose of this cross-sectional study was to assess the patients' point of view about the appropriateness of their hospital stay and to evaluate agreement with health care providers' opinions. It was undertaken in a medical rehabilitation division of the University Hospitals of Geneva in Switzerland. Patients reported their opinion on the justification of their hospital stay on the day of the interview, the reason why they judged their stay to be appropriate, and the place where they should be if not. The patients' health care providers answered the same questions. Two-hundred and fifty-four patients contributed to the evaluation of 314 days of hospitalisation. Only 20 hospital days (6%) were considered unjustified by patients, compared to 63 (20%) by health care providers (p<0.001). There was no agreement between these two judgements (Kappa=0.00,95% CI: -0.09 to +0.09). Similarly, there was little or no agreement concerning the reasons justifying the stay (Kappa=0-0.47) and concerning discharge planning. These results suggest that the definition of an appropriate hospital stay is complex and depends upon each actor's point of view. Better communication between patients and health care providers about decisions related to the hospitalisation process would be desirable.

Attitude of Health Personnel↗

A self-administered questionnaire to measure dependence on cigarettes: the cigarette dependence scale.

A valid measure of dependence on cigarettes is a useful tool for clinicians and researchers. The aim of this study was to develop a new, self-administered measure of cigarette dependence, and to assess its validity. The content of the instrument was generated in qualitative surveys. A long version (114 items) was tested on the internet in 3009 smokers. Subsamples provided retest data after 18 days (n=578), follow-up data after 45 days (n=990) and saliva cotinine (n=105). The study resulted in a 12-item scale labelled the Cigarette Dependence Scale (CDS-12), and in a 5-item version of this scale (CDS-5). Except for tolerance, CDS-12 covers the main components of DSM-IV and ICD-10 definitions of dependence: compulsion, withdrawal symptoms, loss of control, time allocation, neglect of other activities, and persistence despite harm. CDS-5 has similar measurement properties but less comprehensive content. Both scales had a high test-retest reliability (r>or=0.83), and a high internal consistency (Cronbach's alpha>or=0.84). CDS-12 scores were higher in daily smokers than in occasional smokers (+1.3SD units), and were associated with the strength of the urge to smoke during the last quit attempt (R(2)>or=0.25), and with saliva cotinine (R(2)>or=0.17). CDS-12 and CDS-5 scores decreased in daily smokers who switched to occasional smoking at 18-day retest. Dependence scores did not predict smoking abstinence at follow-up. In conclusion, CDS-12 and CDS-5 are reliable measures of cigarette dependence which fulfill several criteria of content validity and construct validity and are sensitive to change over time.

Adolescent↗

Predictors of work satisfaction among physicians.

BACKGROUND: Work satisfaction among physicians is an important concern because it is associated with several important aspects of care, such as the continuity of care and health care costs. In this study, a brief work satisfaction questionnaire was developed, its validity was assessed, and it was used to examine the determinants of work-related satisfaction among a sample of Swiss physicians. METHODS: Based on the literature, a 17-item work satisfaction questionnaire was developed that addressed five dimensions of satisfaction: patient care, work-related burden, income-prestige, personal rewards and professional relations with colleagues. This questionnaire was administered by mail to 1904 doctors practising in Geneva, Switzerland; 1184 (59%) responded. Additional data were collected on physicians' personal and work situation. RESULTS: In general, physicians were more satisfied with the following aspects of their current work situation: patient care, professional relations and personal rewards (intellectual stimulation, opportunities for continuing medical education, enjoyment at work). The lowest satisfaction scores were found for work-related burden (workload, time available for family, friends or leisure, work-related stress, administrative burden) and work-related income and prestige. In multivariate models, variables associated with most dimensions of satisfaction included type of practice (physician in training were less satisfied), specialty (internal medicine specialists and pediatricians were more satisfied), time spent on administrative tasks (globally negative effect), time spent on continuing medical education (globally positive effect). Age and sex had only a minor influence on satisfaction scores. CONCLUSION: Physician work satisfaction is multidimensional and can easily be measured using a short self-administered questionnaire. This instrument could be useful to monitor changes in the near future.

Adult↗

Exposure to radiologic contrast media and an increased risk of treated end-stage renal disease.

BACKGROUND: Radiologic contrast media can cause acute renal failure, but whether their repeated use is associated with end-stage renal disease (ESRD) is unknown. METHODS: We compared 716 incident case subjects of treated ESRD with 361 control subjects, frequency matched on age, drawn from the general population (age, 20-65 years). Participants were interviewed by telephone regarding their previous exposure (before initiation of dialysis for case subjects and the study interview for control subject) to various imaging procedures. RESULTS: As expected, the case subjects reported having more imaging procedures of the kidneys than did control subjects. Excluding persons who had been subjected to examinations of their kidney from the analysis and adjusting for ultrasound examinations and several possible confounders, persons who had a history of one [odds ratio (OR), 2.0; 95% confidence interval (CI), 1.0, 4.0], 2 or 3 (OR, 2.6; 95% CI, 1.2,5.9), or 4 or more (OR, 3.6; 95% CI, 1.0, 12.5) radiocontrast examinations were at higher risk of treated ESRD than persons who reported not having had such procedures. Ultrasound examinations and a history of barium enema were not associated with an increased risk of treated ESRD. CONCLUSION: In the current study, a graded association was present between increasing exposure to radiologic contrast media and higher risk of treated ESRD. Whether exposure to contrast media accelerates progression to ESRD or is merely a noncausal accompaniment to multiple disease processes occurring concurrently cannot be determined from our observational data. However, if these results are confirmed in future prospective studies, they will have important clinical implications.

Adult↗

A randomized trial of four patient satisfaction questionnaires.

BACKGROUND: Patient satisfaction surveys are increasingly used by hospitals. Many questionnaires are available, but little evidence exists to guide the choice of the most suitable instrument. OBJECTIVE: To compare the acceptability and patient perceptions of 4 patient satisfaction questionnaires. RESEARCH DESIGN: Randomized trial of 4 satisfaction questionnaires: Picker, Patient Judgment System (PJS), Sequs, and a locally developed Lausanne questionnaire. SUBJECTS: Patients discharged from 2 Swiss teaching hospitals (n = 2850). MEASURES: Response rates, missing data, completion time, and patient ratings of the questionnaire (5-point agree-disagree scale). RESULTS: Response rates were similar across instruments (Picker: 70%, PJS: 71%, Sequs: 68%, Lausanne: 73%; P= 0.27). The Picker questionnaire had the most missing responses (mean per item: Picker: 3.1%, PJS: 1.9%, Sequs: 1.6%, Lausanne: 1.1%; P<0.001) and took the longest to complete (minutes: Picker: 19.3, PJS: 12.5, Sequs: 13.4, Lausanne: 13.1; P<0.001), but the fewest patients indicated that the questionnaire failed to address at least 1 important aspect of the hospital stay (Picker: 28.2%, PJS: 38.8%, Sequs: 39.1%, Lausanne: 28.9%; P<0.001). Patient evaluations of the questionnaires were generally similar; the most favorable assessment was chosen by approximately half of the respondents (average of 10 items: Picker: 46.5%, PJS: 46.2%, Sequs: 47.4%, Lausanne: 48.2%; P= 0.60). Key survey results differed considerably by questionnaire. CONCLUSIONS: No questionnaire emerged as uniformly better than the others in terms of acceptability and patient evaluations. All 4 could be used for patient satisfaction surveys.

Aged↗

Improving communication between physicians and patients who speak a foreign language.

BACKGROUND: Communication between physicians and patients is particularly challenging when patients do not speak the local language (in Switzerland, they are known as allophones). AIM: To assess the effectiveness of an intervention to improve communication skills of physicians who deal with allophone patients. DESIGN OF STUDY: 'Before-and-after' intervention study, in which both patients (allophone and francophone) and physicians completed visit-specific questionnaires assessing the quality of communication. SETTING: Two consecutive samples of patients attending the medical outpatient clinic of a teaching hospital in French-speaking Switzerland. METHOD: The intervention consisted of training physicians in communicating with allophone patients and working with interpreters. French-speaking patients served as the control group. The outcomes measured were: patient satisfaction with care received and with communication during consultation; and provider (primary care physician) satisfaction with care provided and communication during consultation. RESULTS: At baseline, mean scores of patients' assessments of communication were lower for allophone than for francophone patients. At follow-up, five out of six of the scores of allophone patients showed small increases (P < 0.05) when compared with French-speaking patients: explanations given by physician; respectfulness of physician; communication; overall process of the consultation; and information about future care. In contrast, physicians' assessments did not change significantly. Finally, after the intervention, the proportion of consultations with allophone patients in which professional interpreters were present increased significantly from 46% to 67%. CONCLUSIONS: The quality of communication as perceived by allophone patients can be improved with specific training aimed at primary care physicians.

Adolescent↗

The gynecologist's role in mammography screening in absence of a public health program.

This study examined the role of the gynecologist in a woman's adoption of mammography screening in a population that does not benefit from an organized program of breast cancer screening. We surveyed 486 women ages 50-69 years, randomly selected from the population of Geneva (Switzerland) about recent mammography use, attitudes toward mammography screening (decisional balance), whether they received a recommendation to undergo mammography from their gynecologist and/or family practitioner, visits to gynecologist and family practitioner, and sociodemographic variables. In multivariate analysis, on-schedule mammography was associated with a recent visit to a gynecologist (odds ratio (OR) 4.8, 95% confidence interval (CI) 2.1-10.9), a gynecologist's recommendation for mammography (OR 15.8, 95% CI 6.5-38.6), a positive attitude toward mammography screening (positive score of decisional balance, OR 1.7, 95% CI 1.0-3.0), and being married (OR 2.0, 95% CI 1.2-3.3). Higher decisional balance scores were associated with a recent visit to a gynecologist ( P=0.001), a gynecologist's recommendation for mammography (P=0.001), and income ( P=0.01). Both a recent visit to a gynecologist and a gynecologist's recommendation for mammography were more frequent in women of higher income. This study suggests that gynecologists--but not family practitioners--play a key role both in referring women for mammography and in fashioning women's perceptions of mammography screening. Our data also indicate that a lack of access to a gynecologist and not receiving a gynecologist's recommendation for mammography may explain why low-income women are less likely to get a screening mammogram.

Aged↗

Association of interleukin-4 and interleukin-1B gene variants with Larsen score progression in rheumatoid arthritis.

OBJECTIVE: To perform a genetic association study using markers in the interleukin-1 (IL-1) gene cluster and the IL-4/IL-4 receptor system genes, seeking evidence for involvement in the onset or the erosive outcome of rheumatoid arthritis (RA). METHODS: We tested the allelic distribution of IL-1A (+4845), IL-1B (-511), IL-1B (+3954), IL-1RN (+2018), IL-4 variable number of tandem repeat (VNTR), and IL-4R (+1902) in 233 patients with RA, 99 with polymyalgia rheumatica, and 148 ethnically matched controls. We analyzed the frequency of these gene variants in respect to presence of disease, but also to the degree of radiologic erosions (Larsen score) as a function of disease duration in 157 patients who had available radiographs of both hands. RESULTS: None of the 6 genetic polymorphisms was significantly different in frequency between RA patients and healthy controls or patients with polymyalgia rheumatica. Among RA patients, the rarer (#2) alleles of IL-4 VNTR and IL-1B (-511) were both associated with a milder Larsen score progression: The slope of Larsen progression in the rare allele groups diverged significantly from those of the frequent allele groups after approximately 20 years of disease duration (P < 0.001). CONCLUSION: None of the markers tested were shown to be associated with increased or decreased risk of RA. The rarer alleles of IL-4 VNTR and IL-1B (-511) appear to be associated with a less severe course in RA of long duration.

Aged↗

Alcohol-based handrub improves compliance with hand hygiene in intensive care units.

BACKGROUND: Nosocomial infection is a leading complication in intensive care units. Although hand hygiene is the single most efficient preventive measure, compliance with this simple action remains low. OBJECTIVES: To assess the effect of an intervention to promote hand hygiene and to investigate risk factors for noncompliance in intensive care units. METHODS: We performed 7 observational surveys and implemented a promotional campaign after baseline in medical, surgical, and pediatric intensive care units of a teaching hospital. Health care workers were observed during routine patient care. The intervention consisted of a hospitalwide promotional campaign, including observation and performance feedback, posters display, and distribution of individual bottles of alcohol-based handrub. The main outcome measure was compliance with hand hygiene through handwashing or handrubbing. RESULTS: We observed 2743 opportunities for hand hygiene distributed over 248 periods. Overall compliance increased from 38.4% to 54.5% during the study (P<.001). Although recourse to handwashing remained stable at around 30%, handrubbing increased from 5.4% at baseline to 21.7% at the last survey (P<.001). Compliance increased among nurses and nursing assistants, but remained stable among physicians. Handwashing compliance decreased, on average, by 4.7% for an increase of 10 opportunities for hand hygiene per hour of patient care (P<.001), whereas no such association existed for handrubbing. CONCLUSIONS: Our intervention induced a marked and sustained increase in compliance with hand hygiene. In intensive care units, less time-consuming handrubbing might replace standard handwashing and overcome the barrier of time constraints.

Critical Care↗

Red blood cell methylfolate and plasma homocysteine as risk factors for venous thromboembolism: a matched case-control study.

BACKGROUND: Moderate hyperhomocysteinaemia is a risk factor for venous thromboembolism. We do not know whether this risk depends on homocysteine itself or on components of the homocysteine remethylation pathway, such as methylfolate. We did a case-control study to analyse the relation between the major components of the homocysteine remethylation pathway and risk of venous thromboembolism. METHODS: We measured concentrations of homocysteine, methionine, and folate in plasma, total folate and methylfolate in red-blood cells, and 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T genotype and other known risk factors for venous thromboembolic disease in 243 patients with deep vein thrombosis or pulmonary embolism and controls matched for sex and age. FINDINGS: Concentrations in plasma of homocysteine differed significantly between cases and controls. We noted a strong concentration-dependent association between concentrations of methylfolate in red-blood cells and risk of venous thromboembolism. The adjusted conditional odds ratio ranged from 1.0 for methylfolate 249 microg/L or greater to 7.1 (3.2-15.8) for methylfolate 141 microg/L or less. Methionine concentrations below the median were also independently associated with raised risk of venous thromboembolic disease, as were established risk factors such as high body-mass index, history of cancer, family history of thromboembolism, oral contraceptive use, and factor V Leiden mutation. Furthermore, the association between concentrations of methylfolate in red-blood cells and risk of thromboembolism varied according to MTHFR C677T genotype. INTERPRETATION: Measurement of methylfolate concentrations in red-blood cells might help to identify people at risk of venous thromboembolism.

Adult↗

Men's and women's knowledge and perceptions of breast cancer and mammography screening.

BACKGROUND: Although most men are not directly affected by breast cancer, they participate in decisions influencing breast cancer screening and contribute to shaping the social norm on mammography screening. This study tested the hypothesis that men may be less knowledgeable than women about breast cancer and mammography and have less favorable perceptions of mammography screening. METHODS: A survey was mailed to 952 women and 370 men aged 40 to 80 years, randomly selected from the general population of Geneva, Switzerland. Information collected included knowledge and perceptions about breast cancer and mammography, familiarity with screening recommendations, and perceived usefulness of an organized screening program. RESULTS: Men were almost as knowledgeable as women about breast cancer (difference in z-scores: -0.12; 95% CI: -0.25, 0.02; P = 0.10) and breast cancer screening (difference: -0.12; 95% CI: -0.25, 0.02; P = 0.09). Both men and women perceived mammography screening to be useful, but men had significantly higher z-scores of positive attitude toward mammography than women (difference: 0.28; 95% CI: 0.14, 0.42; P < 0.001). Younger and more educated respondents of either sex were both more knowledgeable and more favorably inclined toward screening. CONCLUSION: Men were as knowledgeable about breast cancer and mammography screening as women but had more favorable attitudes toward breast cancer screening than women. Actions to strengthen community support for mammography screening programs should primarily target older and less educated persons of either sex.

Adult↗

Brief scales for measurement of functional social support and psychological resources in French-speaking adults.

OBJECTIVES: Psychological resources and social support are important determinants of health, but brief and validated scales measuring these dimensions in French are lacking. METHODS: Instruments measuring self-esteem and mastery, and affective and confident social support were administered by mail to 1257 university students. Factor analysis, internal consistency statistics, and correlations with related variables were used to derive abbreviated scales and confirm their validity. RESULTS: Factor analysis and item reduction yielded four brief scales: mastery (4 items), self-esteem (4 items), affective social support (2 items), and problem-solving social support (4 items). All four scales had few missing items and adequate internal consistency (Cronbach's alpha > 0.70). All scores were associated with self-reported general health, and with visits to mental health specialists. Scores of self-esteem and mastery were also associated with physician visits (inversely), and confidence in finishing studies and finding a job. Scores of affective and confident social support correlated with the intensity of social activities and the number of people the respondent could count on. CONCLUSIONS: The abbreviated scales retained adequate psychometric properties and may be usefully applied in health research among similar French-speaking populations.

Adolescent↗

Effect of patient education on self-management skills and health status in patients with asthma: a randomized trial.

We conducted a randomized clinical trial to assess the effectiveness of a newly established education program for adults with asthma. The program was designed to improve patients' health and functional status. Hospitalized patients with asthma were randomly assigned to immediate education or a 6-month waiting list. The education program consisted of three group sessions, delivered by trained educators, and focused on improving patients' self-management skills. Of 253 eligible patients, 131 agreed to participate (66 assigned to immediate education, 65 controls) and 115 (88%) completed the follow-up assessment at 6 months. At follow-up, most indicators of self-management skills and health and functional status had improved significantly among educated patients, but similar improvements were also seen among controls. The trial arms differed significantly on only four variables: patients in the immediate-education group were more likely to develop confidence in their asthma treatment (odds ratio adjusted for baseline [OR] = 2.9; 95% confidence interval [CI]: 1.0 to 8.1), to improve their knowledge of correct inhalation technique (OR = 2.4; 95% CI: 1.0 to 5.7), and to improve knowledge of the peak flow reading that warrants calling a physician (OR = 3.1; 95% CI: 1.4 to 6.7), but they improved less on the Asthma Quality of Life Questionnaire "activity" score (difference: -0.4 on a 1 to 7 scale; 95% CI: -0.8 to 0.0). Use of health services during follow-up was similar in the two groups. The education program did not enhance patients' health and functional status, despite improving a few self-management skills. These results underscore the need for controlled evaluations of education programs.

Adult↗

Screening for pressure ulcer risk in an acute care hospital: development of a brief bedside scale.

To derive a brief bedside pressure ulcer prediction tool for patients admitted to acute care hospitals, we conducted a prospective study of first pressure ulcer incidence among 1,190 consecutive patients hospitalized in selected wards of a Swiss teaching hospital. Baseline predictors included patient age and items from the Norton and Braden ulcer prediction scales. During follow-up, 170 patients developed new pressure ulcers. The predictive ability of baseline assessments decayed over time. Occurrence of first pressure ulcer in the 5 days after admission (129 events) was best predicted by patient age (5 levels), mobility (3 levels), mental status (3 levels), and friction/shear (3 levels). The Fragmment score (sum of friction, age, mobility, mental status) was linearly related to pressure ulcer risk, and its area under the receiver operating characteristic curve (0.80) was higher than for the Norton (0.74; P = 0.006) and Braden (0.74; P = 0.004) scores. This brief pressure ulcer prediction scale performed well in an acute care setting. Use of this scale may facilitate the implementation of pressure ulcer prevention interventions.

Adolescent↗

Gender differences in the psychological determinants of cigarette smoking.

AIMS: To compare the distributions of smoking-related variables and the size of associations between these variables in men and women. DESIGN AND PARTICIPANTS: Mail survey in 2934 daily smokers (1533 women and 1401 men) who volunteered for a smoking cessation trial. Follow-up after 7 months in 2456 people (84%). SETTING: Community setting (French-speaking part of Switzerland, 1998). FINDINGS: Women smoked less than men (18 versus 22 cigarettes per day, p < 0.001), had lower confidence in their ability to refrain from smoking, used more frequently the strategy defined as 'coping with the temptation to smoke' and reported more drawbacks of smoking (gender differences ranged between 0.1 and 0.3 standard deviation units on these scales). There was no gender difference in the distribution of smokers by stage of change. At follow-up, smoking cessation rates were similar in men and women (6% versus 5%, p=0.3). Intention to quit, quit attempts in the previous year and a more frequent use of self-change strategies predicted smoking cessation and were associated with tobacco dependence in both sexes. A more frequent use by women of coping strategies suggests that some women are 'self-restrained' smokers who control their smoking permanently. This could explain lower smoking rates in women. The size of associations between smoking-related variables was similar in men and women. CONCLUSIONS: Even though there were gender differences in the distributions of some smoking-related variables, associations between these variables were similar in men and women. This suggests that smoking behaviour is regulated by similar psychological mechanisms in men and women.

Adaptation, Psychological↗

History of myocardial infarction and stroke among incident end-stage renal disease cases and population-based controls: an analysis of shared risk factors.

BACKGROUND: A history of myocardial infarction (MI) and stroke is more common among incident cases of treated end-stage renal disease (ESRD) than in the general US population. METHODS: Whether this association is the result of shared risk factors or renal dysfunction before ESRD was examined using data from a population-based case-control study of 716 incident patients with ESRD and 361 control subjects of similar age from Maryland, Virginia, West Virginia, and Washington, DC. Medical history including a previous MI and stroke, and dates of these events were obtained by means of a structured telephone interview. RESULTS: After adjustment for age, race, and sex, odds of ESRD were 3.6 (95% confidence interval [CI], 2.0 to 6.5) and 11.1 (95% CI, 4.3 to 28.6) times greater for those with versus without a history of MI and stroke, respectively. Adjustment for long-standing hypertension, diabetes mellitus, and several other potential confounders reduced the odds ratio (OR) of ESRD for those with a history of MI by 77% (OR, 1.6; 95% CI, 0.7 to 3.3) and 39% (OR, 7.2; 95% CI, 2.2 to 23.2) for those with a history of stroke. The OR for ESRD was higher within 5 years of an MI (OR, 2.2; 95% CI, 0.8 to 6.1) or stroke (OR, 14.9; 95% CI, 1.8 to 125) than for more distant MI (OR, 0.8; 95% CI, 0.2 to 2.5) and stroke (OR, 4.5; 95% CI, 1.0 to 19.0) events. CONCLUSION: The high prevalence of a history of MI at ESRD incidence is explained primarily by shared risk factors, but the high prevalence of stroke is not.

Adult↗

Evaluation of quality improvement interventions to reduce inappropriate hospital use.

OBJECTIVE: To assess the impact of process analyses and modifications on inappropriate hospital use. DESIGN: Pre-post comparison of inappropriate hospital use after process modifications. SETTING: The Department of Internal Medicine of the Geneva University Hospitals, Switzerland. PARTICIPANTS: A random sample of 498 patients. INTERVENTIONS: Two processes of care (i.e. non-urgent admissions and transfer to a rehabilitation hospital), which influenced inappropriate hospital use, were identified and modified. The impact of these modifications was then assessed. MAIN OUTCOME MEASURES: The proportion of inappropriate hospital admissions and inappropriate hospital days. RESULTS: As a baseline assessment before quality improvement interventions, the appropriateness of hospital use (admissions and hospital days) was evaluated using the Appropriateness Evaluation Protocol (AEP) in a sample of 500 patients (5665 days). After modification of the two processes through a quality improvement program, inappropriate hospital use was reassessed in a sample of 498 patients (6095 days). Inappropriate hospital admissions decreased from 15 to 9% (P = 0.002) and inappropriate hospital days from 28 to 25% (P = 0.12). CONCLUSION: Using the AEP as a criterion, the quality improvement interventions significantly reduced inappropriate hospital use due to the process of non-urgent admissions, but the reduction of inappropriate hospital days specifically attributed to the transfer to the rehabilitation hospital did not reach statistical significance.

Aged↗