Liability and validity of the Appropriateness Evaluation Protocol in Turkey

Reliability and Validity of the Appropriateness Evaluation Protocol for Public Hospitals in Korea

Objectives

This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea.

Methods

In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared.

Results

The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively.

Conclusions

Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.

Developing of the appropriateness evaluation protocol for public hospitals in iran

Background:

Employment of utilization review instruments is a method for managing costs and efficiency in the healthcare systems.

Objectives:

This study developed an instrument for measuring the level of inappropriate acute hospital admissions and days of care in Iran.

Patients and Methods:

The American version of the Appropriateness Evaluation Protocol (AEP) was modified, using the agreement method, by a multidisciplinary group of physicians. We conducted a retrospective descriptive study of 273 randomly selected patients admitted to Imam Khomeini Hospital of Tehran University of Medical Sciences in Tehran, Iran. For the reliability study, two nurses were asked to review patients’ medical records using the instrument. Validity was appraised by pairs of clinicians, including two general surgeons, two internists and two gynecologists. The degree of consensus between the three pairs of clinicians was compared with that of the nurses.

Results:

Inter-rater and intra-rater reliability testing revealed an excellent level of consensus between the two nurses employing the AEP in all the studied departments. Overall agreement was > 92%, while the specific appropriate agreement and specific inappropriate agreement were > 88% and > 83%, respectively. External validity testing of the instrument yielded a sensitivity > 0.785, specificity > 0.55, and positive and negative predictive values > 0.775 and > 0.555, respectively. The kappa statistic for the nurses who applied the AEP and clinicians using personal judgment were perfect (k > 0.85) and substantial (k > 0.68), respectively.

Conclusions:

The results illustrate that the Iranian version of the AEP (IR-AEP) could be a reliable and valid instrument for assessing the level of inappropriate acute hospital admissions and days of care in the Iranian context.

Reduction in inappropriate hospital use based on analysis of the causes

Background

To reduce inappropriate admissions and stays with the application of an improvement cycle in patients admitted to a University Hospital. The secondary objective is to analyze the hospital cost saved by reducing inadequacy after the implementation of measures proposed by the group for improvement.

Methods

Pre- and post-analysis of a sample of clinical histories studied retrospectively, in which the Appropriateness Evaluation Protocol (AEP) was applied to a representative hospital sample of 1350 clinical histories in two phases. In the first phase the AEP was applied retrospectively to 725 admissions and 1350 stays. The factors associated with inappropriateness were analysed together with the causes, and specific measures were implemented in a bid to reduce inappropriateness. In the second phase the AEP was reapplied to a similar group of clinical histories and the results of the two groups were compared. The cost of inappropriate stays was calculated by cost accounting. Setting: General University Hospital with 426 beds serving a population of 320,000 inhabitants in the centre of Murcia, a city in south-eastern Spain.

Results

Inappropriate admissions were reduced significantly: 7.4% in the control group and 3.2% in the intervention group. Likewise, inappropriate stays decreased significantly from 24.6% to 10.4%. The cost of inappropriateness in the study sample fell from 147,044 euros to 66,642 euros. The causes of inappropriateness for which corrective measures were adopted were those that showed the most significant decrease.

Conclusions

It is possible to reduce inadequacy by applying measures based on prior analysis of the situation in each hospital.

Associated factors and cost of inappropriate hospital admissions and stays in a second-level hospital

The objective of this study was to analyze the variables related to inappropriate admissions and hospital stays and their financial repercussions. This was a descriptive retrospective study in which the Appropriateness Evaluation Protocol (AEP) was applied to a representative sample of 725 hospital admissions and 1350 hospital stays. The cost of inappropriate stays was calculated by cost accounting. The study found that 7.4% of admissions and 24.6% of stays were inappropriate. Inappropriate admissions were significantly related to medical specialties and younger patient age. Inappropriate stays were related to these factors, plus patients being outside their corresponding areas, nonurgent admissions, and low occupancy rate. The cost of the inappropriate admissions and stays was 147 044 euros. Extrapolated to the hospital as a whole this would represent 2125638 euros per year. Steps must be taken to reduce inappropriate admissions and stays to lower health care costs and to reserve hospital resources for patients who genuinely need them.

Validation of a tool assessing appropriateness of hospital days in rehabilitation centres

OBJECTIVE

To develop and validate a list of objective criteria to assess the appropriateness of hospital days for patients admitted to rehabilitation centres and sub-acute care units.

DESIGN

Sixteen appropriateness criteria were defined by a multidisciplinary panel of 33 experts using a formalized consensus method. A single ticked criterion classifies the hospital day as appropriate. Reliability was studied by measuring concordance between two independent and simultaneous ratings using the instrument. External validity was tested by comparing conclusions derived from the instrument with the individual judgements of one, two or three experts on the same random sample of hospital days.

PARTICIPANTS

The assessment on these criteria was performed on a randomized sample of 406 hospital days from 17 French wards.

MAIN OUTCOME MEASURES

Inter-rater reliability and external validity were evaluated using the kappa statistic and prevalence-adjusted and bias-adjusted kappa (PABAK).

RESULTS

The inter-rater reliability test showed a kappa-value of 0.71 [95% confidence interval (95% CI) 0.63-0.78] and a PABAK of 0.77 (95% CI 0.70-0.83). There was a good agreement between the conclusions reached using the instrument and the individual judgements of experts with a kappa coefficient of 0.42 (95% CI 0.35-0.50) and a PABAK of 0.60 (95% CI 0.52-0.67).

CONCLUSIONS

The instrument is reliable and valid for assessing appropriateness of hospital days in rehabilitation centres and sub-acute care units. The next step in this study is the development of a tool for the analysis of causes of inappropriateness.

Appropriate utilization of hospital beds in internal medicine: evaluation in a tertiary care hospital

AIM

To assess the appropriateness of utilization of beds in the internal medicine department of a university hospital.

METHODS

The appropriateness of hospital stay was evaluated using the Appropriateness Evaluation Protocol. A random sample of 402 days of stay was assessed.

RESULTS

One hundred and thirty-nine days of stay (34.6%) were classified as inappropriate. The inappropriate stays were mostly secondary to hospital-related factors. The two major factors for inappropriate stays were 'inappropriate timing/delay in diagnostic procedures/consultations' (27%) and 'delay in obtaining test results' (27%). None of the factors including age, gender, residence and inpatient period was significantly related to inappropriate stay in univariate analysis.

CONCLUSION

This study indicated that a significant portion of stays were inappropriate. Efforts to decrease particularly hospital-related factors associated with inappropriate stay are needed.

Factors affecting appropriateness of hospital utilization in two hospitals in Turkey

To determine the extent of inappropriate hospital use, to investigate factors related to variations in appropriateness, and to identify reasons for inappropriateness, the Appropriateness Evaluation Protocol (AEP) was applied to 2,067 patient days in two hospitals between March 1997 and 1998 in Ankara, Turkey. A substantial amount of inappropriate utilization was found in both hospitals (34.2%, 24.6%). Factors affecting the appropriateness of hospital utilization and reasons for inappropriateness were varied and presented by internal medicine, general surgery, and gynecology services. In general, results of the logistic regression analysis indicated that inappropriateness was significantly associated with admission number (first admission/readmission), admission route (emergent/non-emergent), and day of the week. The most common reason for inappropriateness was diagnostic procedures and/or treatments that could have been carried out on an ambulatory basis. This study demonstrates that the AEP can be used as a tool to improve the efficiency of the Turkish hospitals.