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Reliability and Validity of the Chinese Version Appropriateness Evaluation Protocol.
Wenwei Liu1, Suwei Yuan2, Fengqing Wei2
1Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China.
Plos One
|August 26, 2015
Summary
The Chinese Appropriateness Evaluation Protocol (C-AEP) is a reliable tool for assessing healthcare quality in China. Significant rates of inappropriate hospital admissions and care days were identified, necessitating further research into contributing factors.
Area of Science:
- Health Services Research
- Medical Quality Assurance
- Health Economics
Background:
- The Appropriateness Evaluation Protocol (AEP) is a tool used globally to assess the appropriateness of hospital care.
- Adapting and validating such tools is crucial for ensuring healthcare quality in diverse healthcare systems.
- China's rapidly evolving healthcare landscape requires context-specific tools for evaluating resource utilization.
Purpose of the Study:
- To adapt the existing Appropriateness Evaluation Protocol (AEP) for use in China.
- To validate the psychometric properties of the Chinese version of the AEP (C-AEP).
- To assess the initial prevalence of inappropriate hospital care in Chinese tertiary hospitals using the C-AEP.
Main Methods:
- The original AEP underwent forward and backward translation, followed by expert consultation to create a preliminary C-AEP.
- Reliability and validity were tested on data from acute myocardial infarction and total hip replacement patients in two tertiary hospitals.
- Inter-rater reliability and convergent validity were assessed using Kappa statistics, alongside content and face validity measures.
Main Results:
- The C-AEP demonstrated substantial agreement between reviewers, with Kappa coefficients indicating good inter-rater reliability (0.746 for admissions, 0.743 for days) and convergent validity (0.678 and 0.691, respectively).
- Content and face validity were confirmed by experts and nonprofessionals.
- The study identified that 18.3% of admissions and 28.5% of inpatient days were considered inappropriate by C-AEP reviewers.
Conclusions:
- The C-AEP is a validated and reliable screening tool for assessing healthcare appropriateness in Chinese tertiary hospitals.
- A substantial prevalence of inappropriate hospital utilization was found, highlighting a significant area for improvement.
- Further research is recommended to understand the drivers and risk factors associated with this inappropriateness to guide interventions.
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