Background:Employment of utilization review instruments is a method for managing costs and efficiency in the healthcare systems.Objectives:This study developed an instrument for measuring the level of inappropriate acute hospital admissions and days of care in Iran.Patients and Methods:The American version of the Appropriateness Evaluation Protocol (AEP) was modified, using the agreement method, by a multidisciplinary group of physicians. We conducted a retrospective descriptive study of 273 randomly selected patients admitted to Imam Khomeini Hospital of Tehran University of Medical Sciences in Tehran, Iran. For the reliability study, two nurses were asked to review patients’ medical records using the instrument. Validity was appraised by pairs of clinicians, including two general surgeons, two internists and two gynecologists. The degree of consensus between the three pairs of clinicians was compared with that of the nurses.Results:Inter-rater and intra-rater reliability testing revealed an excellent level of consensus between the two nurses employing the AEP in all the studied departments. Overall agreement was > 92%, while the specific appropriate agreement and specific inappropriate agreement were > 88% and > 83%, respectively. External validity testing of the instrument yielded a sensitivity > 0.785, specificity > 0.55, and positive and negative predictive values > 0.775 and > 0.555, respectively. The kappa statistic for the nurses who applied the AEP and clinicians using personal judgment were perfect (k > 0.85) and substantial (k > 0.68), respectively.Conclusions:The results illustrate that the Iranian version of the AEP (IR-AEP) could be a reliable and valid instrument for assessing the level of inappropriate acute hospital admissions and days of care in the Iranian context.

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.