A pediatric appropriateness evaluation protocol for iran children hospitals

Area of Science:

• Healthcare Management
• Health Services Research
• Pediatric Health

Background:

• Utilization review programs are crucial for decreasing healthcare expenditure and enhancing system efficiency.
• Assessing the appropriateness of hospital admissions and length of stay is vital for optimizing resource allocation.

Purpose of the Study:

• To present a validated instrument for measuring the appropriateness of pediatric admissions and days of stay (DOS) in Iranian public hospitals.
• To adapt and evaluate the Pediatric Appropriateness Evaluation Protocol (PAEP) for the Iranian healthcare context.

Main Methods:

• Modification and adaptation of the American Pediatric Appropriateness Evaluation Protocol (PAEP).
• Retrospective study of 100 randomly selected pediatric patients.
• Reliability testing through inter-reviewer consensus and validity testing against clinician judgment.
• Statistical analysis using the kappa statistic to determine inter-rater reliability and agreement.

Main Results:

• High inter-reviewer agreement for admission criteria (>77%) and DOS (>72%).
• The instrument demonstrated good validity with sensitivity >0.75 and specificity >0.67.
• Substantial agreement was found using the kappa statistic for both reviewers and clinicians (k values ranging from 0.66 to 0.75).

Conclusions:

• The modified PAEP is a reliable and valid tool for assessing the appropriateness of pediatric admissions and DOS in Iran.
• The instrument's findings and methodology can be adapted for similar developing countries, particularly in the Middle East, due to shared cultural and societal contexts.