Abstract
ObjectiveTo adapt the Appropriateness Evaluation Protocol (AEP) to the specific settings of health care in China and to validate the Chinese version AEP (C-AEP).MethodsForward and backward translations were carried out to the original criteria. Twenty experts participated in the consultancy to form a preliminary version of the C-AEP. To ensure applicability, tests of reliability and validity were performed on 350 admissions and 3,226 hospital days of acute myocardial infraction patients and total hip replacement patients in two tertiary hospitals by two C-AEP reviewers and two physician reviewers. Overall agreement, specific agreement, and Cohen’s Kappa were calculated to compare the concordance of decisions between pairs of reviewers to test inter-rater reliability and convergent validity. The use of “overrides” and opinions of experts were recorded as measurements of content validity. Face validity was tested through collecting perspectives of nonprofessionals. Sensitivity, specificity, and predictive values were also reported.ResultsThere are 14 admission and 24 days of care criteria in the initial version of C-AEP. Kappa coefficients indicate substantial agreement between reviewers: with regard to inter-rater reliability, Kappa (κ) coefficients are 0.746 (95% confidence interval [CI] 0.644–0.834) and 0.743 (95% CI 0.698–0.767) of admission and hospital days, respectively; for convergent validity, the κ statistics are 0.678 (95% CI 0.567–0.778) and 0.691 (95% CI 0.644–0.717), respectively. Overrides account for less than 2% of all judgments. Content validity and face validity were confirmed by experts and nonprofessionals, respectively. According to the C-AEP reviewers, 18.3% of admissions and 28.5% of inpatient days were deemed inappropriate.ConclusionsThe C-AEP is a reliable and valid screening tool in China’s tertiary hospitals. The prevalence of inappropriateness is substantial in our research. To reduce inappropriate utilization, further investigation is needed to elucidate the reasons and risk factors for this inappropriateness.
Highlights
Appropriateness of utilization in healthcare requires accessibility, cost-efficiency, and quality [1, 2]
The prevalence of inappropriateness is substantial in our research
From 2008 to 2012, the coverage of health insurance rose from 87.9% to over 95%
Summary
Appropriateness of utilization in healthcare requires accessibility, cost-efficiency, and quality [1, 2]. Like many other developing countries, tends to emphasize universal access to sufficient health resources. The annual growth rate of total healthcare expenditure was around 15% in the last decade [3, 4]. From 2008 to 2012, the average growth of public hospital expenditure was 19.6%, which exceeded that of total healthcare costs [3]. With the rapid increase of hospital use, irrational utilizations, such as prolonged length of stay and admission of non-acute conditions, are widely observed [5]. With regard to hospital stay, according to the China Health Statistical Yearbook, the average length of stay (ALOS) in hospitals was 10.0 days in 2012, while OECD countries are reported to have an ALOS of about eight days (2011) for acute care [3, 7]. All of the above figures underline the pivotal importance to rationalize hospital use in China
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