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Validation of the paediatric appropriateness evaluation protocol in British practice
U Werneke1, H Smith, I J Smith
1London Health Economics Consortium, London School of Hygiene and Tropical Medicine.
Archives of Disease in Childhood
|December 6, 1997
Summary
The North American Paediatric Appropriateness Evaluation Protocol (PAEP) showed limited validity in evaluating British paediatric practice, with moderate agreement compared to expert panels. Its use in different clinical settings requires careful validation.
Area of Science:
- Pediatric healthcare utilization
- Clinical practice evaluation
- Health services research
Background:
- The Paediatric Appropriateness Evaluation Protocol (PAEP) is a tool used to assess the appropriateness of paediatric healthcare services.
- Its validity in different cultural and clinical contexts needs to be established before widespread adoption.
Purpose of the Study:
- To assess the reliability and validity of the North American PAEP for use in British paediatric practice.
- To compare PAEP ratings with expert clinical consensus for emergency paediatric admissions.
Main Methods:
- The PAEP was applied to 418 case records of consecutive emergency paediatric admissions across three Yorkshire hospitals.
- PAEP ratings were compared against the consensus opinions of two expert clinical panels.
Main Results:
- The PAEP identified 32% of admissions as inappropriate, while expert panels rated 36% as inappropriate.
- The validity of the PAEP, measured by agreement beyond chance (kappa = 0.29), was found to be moderate.
- There was a 95% confidence interval of 0.11 to 0.47 for the kappa statistic.
Conclusions:
- The PAEP demonstrates limited validity for evaluating paediatric practice in Britain.
- Healthcare utilization review instruments developed in one clinical culture should be used cautiously in others until validated for the specific setting.