[Organizational appropriateness evaluation of hospital discharges related to DRGs at high risk of inappropriateness in a pediatric observation ward from 2000 to 2004]. / Valutazione della appropriatezza organizzativa dei ricoveri ordinari attribuiti ai DRG ad alto rischio di inappropriatezza effettuati in un Reparto di Osservazione Pediatrica nel periodo 2000-2004.

The aim of the study is to measure and to describe organizational appropriateness of a Paediatric Temporary Observation Ward in the Emergency Department. We selected hospital discharges related to 43 DRGs at high risk of inappropriateness (DPCM 29/11/2001); we studied the relationship between appropriateness and patient's or discharge characteristics. We also investigated the inappropriateness to find tools for improving ward's efficiency. Assessment of selected paediatric clinical records was performed using PRUO protocol and showed that 41.5% of hospital discharges are completely appropriated and only 13.8% are completely not appropriated and, consequently, could be provided in a different organizational setting. Inappropriateness in our study is lower than the expected one; this finding shows that the ward under investigation is able to provide health assistance with good level of appropriateness. The used tool to evaluate appropriateness is a modified PRUO version, specific for pediatric hospital stays. Pediatric PRUO protocol is easy to be applied even if reasonable and shared evaluation criteria do not seem able to recognise some peculiar characteristics of Pediatric Temporary Observation Ward in the Emergency Department.

[Evaluation of the appropriateness of hospital admissions with the Italian version of the AEP in a university hospital]. / Analisi dell'appropriatezza organizzativa dei ricoveri ospedalieri mediante PRUO in un ospedale del Molise.

It has been carried out a survey to evaluate the appropriateness of hospital stay in a university hospital. The aims of the study were: to determine the amount of inappropriate hospital admissions and inappropriate days of stay in relation to either wards and characteristics of admission; to analyse the reasons for inappropriate patient stay. A randomised sample stratified by ward of discharge of 224 medical records were analysed using the Italian version of the Appropriateness Evaluation Protocol. 37.9% of the hospital admissions and 18.9% of hospitalisation days were judged to be inappropriate. The main reasons for categorising an admission or a day of stay as inappropriate were a) delay in performing elective surgery procedures; b) that the patient's problem could be treated on an outpatient basis; c) delay in performing diagnostic examinations. The univariate statistical analysis showed an association between appropriateness of hospital stay and gender age, ward of discharge, length of hospital stay and DRG type (medical/surgical). The study highlights a lower level of inappropriateness compared to the results of other investigations. Hints were also identified for achieving an improved efficiency at hospital level.

[Evaluating hospital appropriateness with different tools: administrative data versus analytic review]. / La valutazione dell'appropriatezza organizzativa con differenti metodi: APPRO e PRUO.

PRUO, a modified version of AEP, is a widely used clinical-based tool to evaluate hospital appropriateness in Italy. We developed the APPRO method for assessing organizational appropriateness using administrative data. APPRO estimates the amount of inappropriate hospitalisation, giving consideration to severity of illness through APR-DRG classification system. The aims of the study were to: measure the agreement between evaluators using PRUO; investigate the relation between APR-DRG severity subgroups and PRUO assessment; asses the validity of APPRO method comparing its performance to PRUO results. We selected 361 hospital episodes assigned to DRG 39 ("lens procedures with or without vitrectomy") and 242 hospital episodes assigned to DRG 183 ("miscellaneous of digestive disorders, age > 17") from three hospitals in 2000. Clinical records were independently evaluated by two pairs of physicians using PRUO. Proportions of inappropriate episodes by hospital and DRG were also estimated through APPRO using data from Lazio regional hospital information system. The agreement between the two pairs of evaluators was high (k=0.93; p<0.0001). We observed no statistically significant association between APR-DRG severity subgroups and inappropriate hospitalisation found by PRUO. APPRO underestimates rates of inappropriate hospitalisation compared to PRUO. It depends on the different characteristics of the tools and particularly on the caution of APPRO in performing the evaluation using routine data.

Analise 42 casos de rotura uterina.I.Considaracoes acerca de indidencia epidemiologia e diagnostico. / Analisys on 42 cases of uterine rupture. I.Considerations on the incidence, epidemiology and diagnosis

Los autores analizan 42 casos de rotura uterina, y observan que la frecuencia de esta entidad no aumenta con el paso de los anos, pese al crecimiento de las tasas de la cesarea. Los principales factores asociados a la rotura uterina fueron la ausencia de atencion prenatal, la multiparidad, la edad materna avanzada, cesareas anteriores, y el trabajo de parto.La asistencia prenatal es destacada como fundamental en la identificacion de factores predisponentes, tales como: abortos, curetajes, miomectomia, cesareas, infecciones uterinas, macrosomias fetales, hidramnios y malformaciones fetales. Finalmente, los autores enfatizan el papel del trabajo de parto como factor desencadenante de este accidente obstetrico

Analise 42 casos de rotura uterina.II Conduta terapeutica. / Analysis of 42 cases of uterine rupture. II - Therapeutic management

Se revisaron 42 casos de rotura uterine, de los que 19 eran completas. Una vez hecho el diagnostico, todas las pacientes fueron sometidas a intervencion quirurgica En 24 enfermas (57,1%) se realizo solamente histerorragia; en 16 casos (38,1%) se hizo histerorrafia y ligadura; y en 2 (4,8%) hubo de practicarse histerectomia total. Los pacientes con rotura uterina completa presentaron tasas de morbilidad mortalidad perinatales mas altas.No hubieron muertes maternas. Se discuten la clasificacion de las roturas uterinas la conducta asistencial y las tecnicas de sutura Los resultados muestran que la histerorrafia es un metodo satisfactorio ya que permite la conservacion de los ciclos menstruales y la funcion reproductiva de las pacientes, sin agravar pronostico

Analise 42 casos de rotura uterina.I.Considaracoes acerca de indidencia epidemiologia e diagnostico. / Analisys on 42 cases of uterine rupture. I.Considerations on the incidence, epidemiology and diagnosis

Los autores analizan 42 casos de rotura uterina, y observan que la frecuencia de esta entidad no aumenta con el paso de los anos, pese al crecimiento de las tasas de la cesarea. Los principales factores asociados a la rotura uterina fueron la ausencia de atencion prenatal, la multiparidad, la edad materna avanzada, cesareas anteriores, y el trabajo de parto.La asistencia prenatal es destacada como fundamental en la identificacion de factores predisponentes, tales como: abortos, curetajes, miomectomia, cesareas, infecciones uterinas, macrosomias fetales, hidramnios y malformaciones fetales. Finalmente, los autores enfatizan el papel del trabajo de parto como factor desencadenante de este accidente obstetrico

Analise 42 casos de rotura uterina.II Conduta terapeutica. / Analysis of 42 cases of uterine rupture. II - Therapeutic management

Se revisaron 42 casos de rotura uterine, de los que 19 eran completas. Una vez hecho el diagnostico, todas las pacientes fueron sometidas a intervencion quirurgica En 24 enfermas (57,1%) se realizo solamente histerorragia; en 16 casos (38,1%) se hizo histerorrafia y ligadura; y en 2 (4,8%) hubo de practicarse histerectomia total. Los pacientes con rotura uterina completa presentaron tasas de morbilidad mortalidad perinatales mas altas.No hubieron muertes maternas. Se discuten la clasificacion de las roturas uterinas la conducta asistencial y las tecnicas de sutura Los resultados muestran que la histerorrafia es un metodo satisfactorio ya que permite la conservacion de los ciclos menstruales y la funcion reproductiva de las pacientes, sin agravar pronostico