{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T14:07:21Z","timestamp":1740146841432,"version":"3.37.3"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Shanghai Public Health Excellent Talent Project","award":["GWV-10.2-YQ51"],"award-info":[{"award-number":["GWV-10.2-YQ51"]}]},{"DOI":"10.13039\/501100010031","name":"Postdoctoral Research Foundation of China","doi-asserted-by":"publisher","award":["2019M661537"],"award-info":[{"award-number":["2019M661537"]}],"id":[{"id":"10.13039\/501100010031","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010224","name":"Philosophy and Social Science Foundation of Hunan Province","doi-asserted-by":"publisher","award":["2019EZZ003"],"award-info":[{"award-number":["2019EZZ003"]}],"id":[{"id":"10.13039\/501100010224","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72004136"],"award-info":[{"award-number":["72004136"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Although the appropriateness of hospital utilization of adults and the elderly in China was audited by several studies, the appropriateness of hospital use by children in Shanghai remains to be determined. This study aims to assess the level of inappropriate hospital admissions and hospital days, to detect factors associated with inappropriateness, and to elucidate reasons for inappropriateness.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective review of the records of 291 admissions and 1449 hospital days of children inpatients from a secondary hospital in Shanghai was performed by two reviewers using the Chinese version Pediatric Appropriateness Evaluation Protocol (C-PAEP). Demographics, socio-economic characteristics, and other admission- or hospital stay-related information were collected and analyzed to determine factors associated with inappropriateness utilizing multivariate regression models.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>38.5% (n = 112) of admissions and 9.5% (n = 137) of hospital days were categorized as inappropriate, according to the C-PAEP. Children who were non-Shanghai residents (<jats:italic>p<\/jats:italic> &lt; 0.001), admitted through the emergency sector (<jats:italic>p<\/jats:italic> = 0.030), and\/or received services in a surgical ward (<jats:italic>p<\/jats:italic> &lt; 0.001) had a higher risk of being admitted inappropriately. Payment method (<jats:italic>p<\/jats:italic> = 0.006), service type (<jats:italic>p<\/jats:italic> &lt; 0.001), comorbidity (<jats:italic>p<\/jats:italic> = 0.016), length of stay (<jats:italic>p<\/jats:italic> = 0.007), and appropriateness of admission (<jats:italic>p<\/jats:italic> &lt; 0.001) were found to be associated with prevalence of inappropriate hospital days. Approximately three-fourths of the inappropriate admissions were premature admissions (75.9%, n = 85). The most frequent reasons for inappropriate hospital days were awaiting test results (34.3%, n = 47), awaiting surgery (19.7%, n = 27), awaiting test execution (10.9%, n = 15), and family unprepared for home care (10.9%, n = 15).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Although the extent of inappropriate hospital days was moderate compared with that found by previous investigations, the prevalence of inappropriateness of admission was considerable. To enhance the appropriateness of hospital care for children, interventions could be implemented according to the associated factors and identified causes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0275645","type":"journal-article","created":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T17:26:27Z","timestamp":1665077187000},"page":"e0275645","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and associated factors of inappropriate hospital admissions and days of children in a secondary hospital in Shanghai, China"],"prefix":"10.1371","volume":"17","author":[{"given":"Wenwei","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huimin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haichen","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tongzhou","family":"Lyu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0217-8614","authenticated-orcid":true,"given":"Suwei","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"volume-title":"China\u2019s Health Statistics Yearbook 2019","year":"2019","author":"National Health and Family Planning Commission of the People\u2019s Republic of China","key":"pone.0275645.ref001"},{"volume-title":"China\u2019s Health Statistics Yearbook 2017","year":"2017","key":"pone.0275645.ref002"},{"issue":"7","key":"pone.0275645.ref003","first-page":"64","article-title":"Controlling the unreasonable growth of medical expenditure in public hospitals was the important task of health reform","author":"G Huang","year":"2016","journal-title":"Chinese Health Economics"},{"issue":"3","key":"pone.0275645.ref004","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1093\/intqhc\/7.3.253","article-title":"The Evolution of Hospital Utilization Review Methods in the United States","volume":"7","author":"JD Restuccia","year":"1995","journal-title":"Int J Qual Health Care"},{"issue":"8","key":"pone.0275645.ref005","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1097\/00005650-198108000-00005","article-title":"The appropriateness evaluation protocol: a technique for assessing unnecessary days of hospital care","volume":"19","author":"PM Gertman","year":"1981","journal-title":"Med Care"},{"issue":"2","key":"pone.0275645.ref006","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1542\/peds.84.2.242","article-title":"Assessing the need to hospitalize children: pediatric appropriateness evaluation protocol","volume":"84","author":"BE Kreger","year":"1989","journal-title":"Pediatrics"},{"issue":"5","key":"pone.0275645.ref007","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.26719\/2009.15.5.1126","article-title":"Appropriateness of hospital admissions in general hospitals in Egypt","volume":"15","author":"M Al-Tehewy","year":"2009","journal-title":"East Mediterr Health J"},{"issue":"11","key":"pone.0275645.ref008","doi-asserted-by":"crossref","first-page":"643","DOI":"10.15171\/ijhpm.2016.53","article-title":"Bed utilisation in an Irish regional paediatric unit\u2013a cross-sectional study using the Paediatric Appropriateness Evaluation Protocol (PAEP)","volume":"5","author":"C \u00d3hAiseadha","year":"2016","journal-title":"Int J Health Policy Manag"},{"issue":"6","key":"pone.0275645.ref009","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1159\/000339084","article-title":"Appropriateness of pediatric hospitalization in a general hospital in Kuwait","volume":"21","author":"MH Shafik","year":"2012","journal-title":"Med Princ Pract"},{"issue":"7","key":"pone.0275645.ref010","first-page":"501","article-title":"Appropriateness of pediatric admissions to a tertiary care facility in Israel","volume":"3","author":"M Katz","year":"2001","journal-title":"Isr Med Assoc J"},{"key":"pone.0275645.ref011","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1007\/s10389-010-0325-y","article-title":"Appropriateness of admission and days of stay in pediatric hospital in Ancona, Italy","volume":"18","author":"D. 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