A Pediatric Appropriateness Evaluation Protocol for Iran Children Hospitals

BACKGROUND: Applying utilization review programs is an appropriate solution to decrease the expenditure, and to increase the efficiency of healthcare systems. OBJECTIVES: This paper presents an instrument to measure the level of appropriate admissions and days of stay (DOS) in the pediatric public hospitals of Iran. MATERIALS AND METHODS: The American version of the Pediatric Appropriateness Evaluation Protocol (PAEP) was modified and adjusted by our group of physicians. They carried out a retrospective study over 100 randomly selected patients. The reliability of the instrument was tested based on the consensus of reviewers using PAEP. In addition, the external validity of the instrument was studied by comparing the evaluations of the reviewers using PAEP and the individual judgments of three clinicians in two public teaching hospitals. Finally, reliability and validity were also calculated by the kappa statistic. RESULTS: With respect to the inter-reliability testing, there was a high level of agreement between reviewers applying the instrument in the admissions criteria and days of stay. Overall agreement was > 77%; also specific inappropriate agreement and specific appropriate agreement were > 61%, and > 72%, respectively. Regarding the validity of the testing, the instrument had a sensitivity of > 0.75, specificity of > 0.67, as well as positive and negative predictive values of > 0.93, and > 0.55, respectively. The kappa statistic for the reviewers (using the instrument for admission and days of stay criteria) were substantial (k = 0.75.5 and 0.71). They were also substantial for clinicians (k = 0.73 and 0.66). CONCLUSIONS: These results showed that the modified PAEP is a reliable and valid instrument to study the appropriateness of admission and days of stay in Iran hospitals. As the developing countries, particularly, Middle East countries have the same status and culture, the result of this study (with minor changes) could be applied in these countries too.