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BMJ Open. 2019 May 1;9(4):e026443. doi: 10.1136/bmjopen-2018-026443.

Determinants of inappropriate admission of elderly people in county-level hospitals: a cross-sectional study in rural China.

Hu X#1,2, Gao H#1,2, Zhang Y1,2, Li H1,2, Su D1,2, Chang J1,2, Jiang D1,2, Lei S1,2, Chen Y1,2.

Author information

1
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
2
Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Province, Wuhan, Hubei, China.
#
Contributed equally

Abstract

OBJECTIVE:

The purpose of this paper is to investigate the characteristics and determinants of inappropriate admission to hospital of elderly people in rural China.

DESIGN:

A cross-sectional study of a comparison between the elderly and non-elderly groups of people.

SETTING:

The survey was conducted on the largest county-level general hospitals in four counties in central and western China.

PARTICIPANTS:

A total of 652 rural patients admitted in hospitals were surveyed, who were divided into two groups according to age: elderly group (n=230, age ≥60 years) and non-elderly group (n=422, age <60 years).

PRIMARY MEASURES:

The Chinese version of the appropriateness evaluation protocol was used to evaluate the inappropriate admission rates. The interactive regression models based on the relationship of age (elderly and non-elderly) with other factors and binary logistic regression models were used in the analysis of the specific factors and determinants of the inappropriate admission of elderly people.

RESULT:

The inappropriate admission rate for the rural elderly was 30%, which was lower than that of the non-elderly people (40.8%). Compared with the non-elderly group, women in the elderly group (OR=0.33, 95% CI 0.15 to 0.73) had a lower incidence of inappropriate admission, and elderly people with chronic diseases (OR=3.33, 95% CI 1.23 to 9.04) were more prone to being inappropriately admitted than non-elderly people with chronic diseases. The binary logistic regression analysis shows that county, age (OR=0.94. 95% CI 0.90 to 0.99), gender (OR=0.49, 95% CI 0.25 to 2.98), department and response to doctor's admission request were the determinants of the inappropriate admission of elderly patients.

CONCLUSION:

The inappropriate admission rate of elderly people in rural China was high. We found that gender and chronic disease are the specific factors that were specific to non-elderly people. County, age, gender, department and response to a doctor's admission request had substantial influence on the inappropriate admission of the elderly in rural China.

KEYWORDS:

elderly; health policy; inappropriate admission; quality in health care; rural china

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