[Evaluating hospital appropriateness with different tools: administrative data versus analytic review]

Area of Science:

• Healthcare Management
• Health Services Research
• Medical Informatics

Background:

• The Appropriateness Protocol and Referral Opinion (PRUO) is a clinical tool for evaluating hospital appropriateness in Italy.
• The Administrative data-based Appropriateness (APPRO) method was developed to assess organizational appropriateness using administrative data and the All Patient Refined Diagnosis Related Groups (APR-DRG) classification system.

Purpose of the Study:

• To measure inter-evaluator agreement using the PRUO tool.
• To investigate the relationship between APR-DRG severity subgroups and PRUO assessments.
• To validate the APPRO method by comparing its performance against PRUO results.

Main Methods:

• Two physician pairs independently evaluated 361 hospital episodes (DRG 39) and 242 (DRG 183) using PRUO.
• The APPRO method estimated inappropriate hospitalizations using administrative data from the Lazio regional hospital information system.
• Inter-evaluator agreement was assessed using Cohen's kappa coefficient.

Main Results:

• High agreement was found between the two physician pairs using PRUO (k=0.93; p<0.0001).
• No significant association was observed between APR-DRG severity subgroups and inappropriate hospitalizations identified by PRUO.
• The APPRO method underestimated rates of inappropriate hospitalizations compared to PRUO.

Conclusions:

• The PRUO tool demonstrates reliable inter-evaluator agreement for assessing hospital appropriateness.
• The APPRO method, while utilizing routine data, tends to underestimate inappropriate hospitalizations due to its inherent characteristics and cautious approach.
• Further research is needed to reconcile the differences between clinical-based and administrative data-based appropriateness evaluation methods.