Appropriate or Inappropriate? Determination and Comparison of Screening Measures for Hospital Admission Criteria

• Activity Number: 409
• Type: Contributed
• Date/Time: Wednesday, August 6, 2003 : 2:00 PM to 3:50 PM
• Sponsor: Section on Health Policy Statistics
• Author(s): Anita Bhatia*+ and William Mark Krushat and Sheila Blackstock
• Companies: Centers for Medicare and Medicaid Services and Centers for Medicare & Medicaid Services
• Keywords: Medicare ; hospital admissions ; appropriateness criteria

Abstract

Admission criteria sets are used to screen medical records for appropriateness (medical necessity and setting) of hospital admission. As a paucity of information on comparability or accuracy of these tools exists, we determined screening measures for three criteria sets using inpatient acute care medical records. A sample of records that had passed or failed screening with the Intensity of Service, Severity of Illness, Discharge (ISD) screens and had undergone admission review were rescreened with the Managed Care Appropriateness Protocol (MCAP) and a Medicare contractor criteria (MCC). PROCs SURVEYSELECT and SURVEYMEANS (SAS) were used for sampling and analyses; 90% Cis were calculated. Compared with MCAP, ISD had more inappropriate admissions, 33.0% (23.7, 42.3) vs. 15.1% (8.1, 22.1), higher sensitivity, 69.7% (61.1, 78.2) vs. 44.0% (32.2, 55.7) and lower specificity, 68.9% (59.2, 78.7) vs. 86.4% (79.0, 93.8). The MCC consistently performed between the other criteria, but did not differ from either. These results suggest considerable differences in appropriateness determinations between admission criteria sets with review volume counterbalancing inappropriate admissions detected.