Recorded presentation

Daniel Z. Louis, MS¹, Andrea Donatini, MSc², Masahito Jimbo, MD, PhD¹, Joseph S. Gonnella, MD³, Carol Rabinowitz⁴, Monica Fiorini², Marianna Rossi², Sabine Mall², Gioia Virgilio², Elaine J. Yuen, PhD⁴, Vittorio Maio, PharmD⁵, and Francesco Taroni, MD². (1) Center for Research in Medical Education and Health Care, Jefferson Medical College, 1025 Walnut St, Suite 119, Philadelphia, PA 19107, 215-955-6959, daniel.louis@jefferson.edu, (2) Agenzia Sanitaria Regionale, Viale Aldo Moro, 21, Bologna, 40127, Italy, (3) Thomas Jefferson University, 1025 Walnut St, Philadelphia, PA 19107, (4) Jefferson Medical College, Thomas Jefferson University, Suite 119, 1025 Walnut Street, Center for Research in Medical Education and Health Care, Philadelphia, PA 19107, (5) Department of Health Policy, Jefferson Medical College, Suite 119, 1025 Walnut Street, Philadelphia, PA 19107

The Italian Ministry of Health has identified an “essential level of services” that all 21 regions must provide including 43 DRGs that may include inappropriate acute hospital admissions. The regions are not required to provide acute hospital care if patients can be treated in alternative settings without jeopardizing quality. The goal of this project was to develop an approach to differentiating appropriate from inappropriate admissions that can be used with existing hospital data. Using DRGs and Disease Staging a classification was developed and applied to the hospital discharge abstract database to evaluate the level of potentially inappropriate admissions. Initial analyses of patients between 16 and 64 years old who had 35,403 acute hospitals admissions and 47,562 day-hospital admissions for the selected DRGs, of which, 15,450 acute admissions were judged to be potentially inappropriate (18.6% of total admissions and 43.6% of the acute admissions). Substantial variation was observed in the proportion of potentially inappropriate admissions by DRG, hospital type, and geographically defined Local Health Units within the Region. Emilia-Romagna Region has produced an “Atlas of appropriateness of hospital use” to assist hospital and local health unit managers in identifying the appropriate level of alternative, lower intensity, treatment settings for patients who do not need acute care hospitalization and, is considering changes to the DRG-based hospital financing system to promote managerial and organizational efficiency.

Learning Objectives:

• Understand the context of health care financing in Italy, an approach to the assessment of appropriateness of hospital use and how the results can be used for hospital financing and planning.

Keywords: Financing, Planning

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Co-author of Disease Staging classification used in project, receive royalties.

Recorded presentation