Does Clinical Governance Influence Appropriateness In Hospital Stay? [Comunicazione orale 1175]

Objectives: Clinica Governance provides a framework for assessing and improving clinical quality into a single coherent program. Organisational appropriateness is aimed to the best health outcomes and a proper use of resources. This study aims to verify the likely relationship between Clinical Governance and appropriateness of hospital stay. Methods: A cross-­‐sectional study was conducted in 2012 in an Italian Teaching Hospital. The OPTIGOV© (OptimisingHealthCareGovernance) methodology was used to quantify the level of implementation of Clinical Governance and its main dimensions. Organisational appropriateness was measured retrospectively by analysing through the Italian version of the Appropriateness Evaluation Protocol 1460 medical records random selected. Spearman-­‐correlation and multiple linear regression were used to test the relationship between the percentage of inappropriate days of hospital stay and the Clinical Governance implementation levels. Results: 47 Hospital Units were assessed. The percentage of inappropriate days of hospital stay showed an inverse correlation with all the main Clinical Governance dimensions, except Risk Management. Adjusted multiple regression analysis showed a significant association between the percentage of inappropriate days and the overall Clinical Governance score (β=-­‐0.28;p<0.001;R-­‐squared=0.8). EBM and Clinical Audit represented the Clinical Governance dimensions most associated with organisational appropriateness. Conclusion: The study suggests that the evaluation of both Clinical Governance and appropriateness through standardised and repeatable tools, such as OPTIGOV and AEP, is a key strategy for healthcare quality. The relationship between them underlines the central role of Clinical Governance, and especially of EBM and Clinical Audit, in determining a rationale improvement of appropriateness levels.