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Pediatric Appropriate Evaluation Protocol for India (PAEP-India): Tool for Assessing Appropriateness of Pediatric
Manoja Kumar Das1, Narendra Kumar Arora2, Ramesh Poluru1
1The INCLEN Trust International, Okhla Industrial Area, Phase I, New Delhi, India.
Insights
The Pediatric Appropriateness Evaluation Protocol for India (PAEP-India) tools demonstrate high reliability for assessing pediatric hospitalization appropriateness. These validated tools can guide admission decisions and hospital stay evaluations in diverse Indian healthcare settings.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Clinical Appropriateness Tools
Background:
- Assessing the appropriateness of pediatric hospitalizations is crucial for optimizing resource utilization and patient care.
- Existing evaluation protocols may not be suitable for the diverse Indian healthcare landscape.
- Developing context-specific tools is essential for reliable assessment.
Purpose of the Study:
- To develop and evaluate the Pediatric Appropriateness Evaluation Protocol for India (PAEP-India).
- To assess the inter-rater reliability and appropriateness of hospitalization using the developed PAEP-India tools.
- To adapt existing PAEP tools for the Indian pediatric population.
Main Methods:
- A cross-sectional study involving adaptation of existing PAEP tools via a semi-Delphi process with pediatricians.
- Development of two PAEP-India tools: one for newborns (≤28 days) and one for children (>28 days to 18 years).
- Application of PAEP-India tools to case records from medical colleges and health facilities in India, with blinded evaluation by two pediatricians.
Main Results:
- In medical college cases (n=274), 97.8% of hospitalizations were deemed appropriate with 98.9% inter-rater agreement (k=0.66).
- In southern Indian infant cases (n=622), 80.5% of admissions were appropriate with 96.1% inter-rater agreement (k=0.89).
- The PAEP-India tools showed high reliability across different settings.
Conclusions:
- The developed PAEP-India tools for newborns and children are simple, objective, and reliable.
- These tools are applicable in diverse Indian healthcare settings for assessing admission appropriateness and hospital stay.
- PAEP-India holds potential for guiding clinical decisions and future evaluation for insurance reimbursement purposes.
Objective:
To develop and assess Pediatric Appropriateness Evaluation Protocol for India (PAEP-India) for inter-rater reliability and appropriateness of hospitalization.
Design:
Cross-sectional study.
Setting:
The available PAEP tools were reviewed and adapted for Indian context by ten experienced pediatricians following semi-Delphi process. Two PAEP-India tools; newborn (≤28 days) and children (>28 days-18 years) were developed. These PAEP-India tools were applied to cases to assess appropriateness of admission and inter-rater reliability between assessors.
Participants:
Two sets of case records were used: (i) 274 cases from five medical colleges in Delhi-NCR [≤28 days (n=51); >28 days to 18 years (n=223)]; (ii) 622 infants who were hospitalized in 146 health facilities and were part of a cohort (n= 30688) from two southern Indian states.
Interventions:
Each case-record was evaluated by two pediatricians in a blinded manner using the appropriate PAEP-India tools, and 'admission criteria' were categorized as appropriate, inappropriate or indeterminate.
Outcome Measures:
The proportion of appropriate hospitalizations and inter-rater reliability between assessors (using kappa statistic) were estimated for the cases.
Results:
97.8% hospitalized cases from medical colleges were labelled as appropriate by both reviewers with inter-rater agreement of 98.9% (k=0.66). In the southerm Indian set of infants, both reviewers labelled 80.5% admissions as appropriate with inter-rater agreement of 96.1% (k= 0.89).
Conclusions:
PAEP-India (newborn and child) tools are simple, objective and applicable in diverse settings and highly reliable. These tools can potentially be used for deciding admission appropriateness and hospital stay and may be evaluated later for usefulness for cost reimbursements for insurance proposes.
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