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The objective was to assess the extent of inappropriate hospital admission and stay in an adult patient population and identify potential correlates of such inappropriateness. Design: a cross-sectional survey on a sample of 1,082 in-patients using a modified version of the appropriateness evaluation protocol (AEP). Setting: adult acute departments in a 950 bed teaching hospital in the greater Milan area. The patient sample consisted of patients cared for at 1 of the participating departments on any of 3 index days between October 1989 and June 1990. The results show that overall 27% of the admissions and 40% of the hospital days were inappropriate. The rate of inappropriate admissions was higher for patients admitted during week days and was also significantly associated with the admitting ward and the age of the patient. Inappropriate hospital-day stays were related to the type of ward and to the location during the stay, with those sampled in the later part of their stay having the highest rate of inappropriateness. Most of the hospital days rated as not appropriate did not require any further stay (75%). Conclusions: a substantial proportion of hospital use was found to be medically unnecessary and, for the most part, due to hospital functioning or the behaviour of the doctors. Some properties of the AEP (high inter-rater reliability, predictivity of expected associations) were also confirmed. The basic features of this revised version of the AEP make it a good candidate for becoming of great importance in monitoring the effect of the changes the Italian National Health Service is currently undergoing. [ABSTRACT FROM AUTHOR]

To assess the extent of inappropriate hospital use in an adult in-patients population we used a modified version of the Appropriateness Evaluation Protocol (A.E.P.) to evaluate retrospectively a cross-section of 273 patient-days in a large teaching hospital in the Greater Milan area. Overall, 41% were judged to represent inappropriate hospital use on the basis of the protocol's criteria. The rate of inappropriate hospital use was significantly associated with admitting specialty, ranging from 12% for surgery, to 20% for cardiology and to about 60% in psychiatric, geriatrics and neurology departments (p less than 0.01). Hospital days of patients with longer stays were more frequently inappropriate: a statistically significant trend of inappropriateness emerged ranging from 30% among patients with total length of stay (LOS) of 1-10 days to 60% among those with LOS greater than 30 days (p less than 0.01). This study confirms that there is a substantial rate of unnecessary use of hospitals but that such inappropriateness does not seem in most cases to be easily modifiable through "simple" organizational changes.

We examined cognitive functions and central conduction velocities in 20 patients, over 63-year old, with NIDDM compared with 20 normal, age-matched controls. Mean conduction velocity of median nerve, was significantly lower in diabetics than in controls, but absolute values were within normal range. Neurological examination showed clinical signs of lower limbs neuroperipheral involvement. Only one cognitive subtest performance was abnormal whereas there was no impairment in central conduction velocities. In our study population, although median nerve conduction velocity values may introduce a bias of low peripheral neuropathy incidence, there was no evidence of a massive or progressive specific central nervous system involvement caused by NIDDM.