The appropriateness of hospital admissions has become the focal point of the legislative health Italians of the last 15/20 years, associated with the continuous improvement of quality care to be granted in the three macro-care: health care in collective living environment and working conditions, support and assistance the district hospital with the aim of rationalizing health expenditure transform the resources used for hospital care in the other two areas.
In the U.S. the issue of appropriateness of medical care has occurred much earlier because the U.S. Health System, based primarily on private insurance, provides for the payment of benefits provided by health facilities. Still are pioneers in the adoption of tools that enables the strictly monitor the appropriateness of care setting "delivery of services by the health facilities.
Among these tools are driving Prevention Quality Indicator (PQI) of the Agency for Healthcare Research and Quality as the U.S., providing a number of "sentinel indicators", highlights the lack of good quality health care is delivered to outpatient that territorial.