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Development of the Paediatric Appropriateness Evaluation Protocol for use in the United Kingdom
1School of Primary Care, Faculty of Medicine, University of Manchester, Rusholme Health Centre, UK.
Insights
A modified Paediatric Appropriateness Evaluation Protocol (PAEP) reliably assessed paediatric hospital admissions and care days. Trained reviewers using the PAEP showed excellent agreement, improving upon subjective clinical judgment.
Area of Science:
- Healthcare quality assessment
- Paediatric hospital management
- Clinical audit tools
Background:
- Measuring appropriate paediatric hospital admissions and length of stay is crucial for resource management.
- Existing methods for assessing appropriateness may lack reliability.
- Development of a standardized instrument is needed to evaluate paediatric care quality.
Purpose of the Study:
- To develop and validate an instrument for measuring appropriate paediatric hospital admissions.
- To assess the reliability of the instrument in determining appropriate days of care.
- To evaluate the instrument's acceptability and utility in the UK clinical setting.
Main Methods:
- Modification of the American Paediatric Appropriateness Evaluation Protocol (PAEP) based on expert consensus.
- Pilot testing of the modified PAEP on a random sample of 47 paediatric admissions.
- Reliability testing using kappa statistics to compare PAEP ratings with subjective clinical judgment.
Main Results:
- Excellent inter-rater agreement (kappa = 0.848) for admission criteria using the PAEP.
- Good agreement (kappa = 0.54) for days of care criteria.
- Significantly higher reliability for trained reviewers using the PAEP compared to subjective clinical judgment (kappa = 0.345).
Conclusions:
- The modified PAEP is a reliable and acceptable tool for retrospectively assessing the appropriateness of paediatric hospital admissions in the UK.
- The instrument demonstrates superior performance compared to unassisted clinical judgment.
- Implementation of the PAEP can enhance the quality and efficiency of paediatric hospital care.
Background:
This paper describes a study to develop and test an instrument to measure the level of appropriate admissions and days of care in the paediatric hospital population.
Methods:
The American version of the Paediatric Appropriateness Evaluation Protocol (PAEP) was modified by the consensus views of a panel of paediatricians and general practitioners. Reliability was tested in a pilot study in a random sample of 47 admissions from two district general hospitals.
Results:
The agreement beyond chance for the raters using the PAEP for admission criteria was excellent (kappa = 0.848). It was poor (kappa = 0.345) for clinicians using subjective judgement. The agreement beyond chance for the day of care criteria was good (kappa =0.54). Trained reviewers achieved much higher reliability using the PAEP.
Conclusion:
The modified PAEP achieved high reliability and was judged acceptable by clinicians to retrospectively assess the appropriateness of admissions in the UK setting.