Causes of inappropriate hospital days: development and validation of a French assessment tool for rehabilitation centres

Objective. To develop and validate a list of criteria to assess the causes of inappropriate hospital days for patients admitted to rehabilitation centres and sub-acute care units. Design. The tool was developed by a multidisciplinary panel of 33 experts, using a formalized consensus method. It collects both the needs of patients (distinguishing healthcare needs (9 criteria) and accommodation needs (9 criteria)) and the reasons for inappropriateness (19 criteria). Inappropriate days were identified using the tool to assess appropriateness of hospital days validated previously. Reliability was studied by measuring agreement between two independent simultaneous ratings. Setting. The validation study was performed on a randomized sample of 576 hospital days from 22 wards in France. Main Outcome Measures. Inter-rater reliability was evaluated using the k-statistic and prevalence-adjusted and bias-adjusted kappa (PABAK). Results. For patient accommodation needs, the inter-rater reliability was estimated by a k-value of 0.80 (95% confidence interval (95% CI) 0.66 – 0.92) and a PABAK of 0.80 (95% CI 0.63 – 0.91). There was good agreement on the reasons for inappropriateness, with k-values from 0.30 to 0.60 and PABAK from 0.46 to 0.69. The k-coefficient varied from 0.33 to 0.49 for the assessment of patient healthcare needs, with PABAK ranging from 0.49 to 0.72. Conclusions. The instrument is suitable and valid to assess the causes of inappropriate hospital days in rehabilitation centres and sub-acute care units. The study showed that the tool can be easily used by healthcare workers, which makes it useful for quality improvement.