Liability and validity of the Appropriateness Evaluation Protocol in Turkey

Area of Science:

• Healthcare Management
• Health Services Research
• Nursing Quality Assurance

Background:

• Assessing the appropriateness of hospital care is crucial for resource optimization and quality improvement.
• The Appropriateness Evaluation Protocol (AEP) is a widely used tool for this purpose.
• Validating the AEP in diverse healthcare contexts, such as Turkey, is essential.

Purpose of the Study:

• To evaluate the inter-rater reliability of the AEP when applied by nurses.
• To determine the convergent validity of the AEP by comparing nurse assessments with expert physician judgments.
• To assess the AEP's performance within the Turkish healthcare system.

Main Methods:

• Two nurses concurrently applied the AEP to patient-days across internal medicine, surgery, and gynecology departments.
• Inter-rater reliability was assessed using overall and specific agreement percentages and Kappa statistics.
• Convergent validity was tested by comparing AEP assessments with expert physician judgments, calculating sensitivity, specificity, and predictive values.

Main Results:

• High inter-rater reliability was observed, with overall agreement ranging from 90.7% to 97.6%.
• The AEP demonstrated good validity, with sensitivity (0.83-0.97), specificity (0.62-0.80), and predictive values (0.84-0.95).
• Kappa statistics indicated substantial to almost perfect agreement for both reliability and validity across different departments.

Conclusions:

• The Appropriateness Evaluation Protocol (AEP) is a reliable and valid instrument for assessing the appropriateness of patient care in Turkey.
• The findings support the use of the AEP by nurses for quality assessment in Turkish hospitals.
• The study validates the AEP's utility in a non-Western healthcare context.