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Reliability and Validity of the Chinese Version Appropriateness Evaluation Protocol

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  • Wenwei Liu
  • Suwei Yuan
  • Fengqing Wei
  • Jing Yang
  • Zhe Zhang
  • Changbin Zhu
  • Jin Ma

Abstract

Objective: To adapt the Appropriateness Evaluation Protocol (AEP) to the specific settings of health care in China and to validate the Chinese version AEP (C-AEP). Methods: Forward and backward translations were carried out to the original criteria. Twenty experts participated in the consultancy to form a preliminary version of the C-AEP. To ensure applicability, tests of reliability and validity were performed on 350 admissions and 3,226 hospital days of acute myocardial infraction patients and total hip replacement patients in two tertiary hospitals by two C-AEP reviewers and two physician reviewers. Overall agreement, specific agreement, and Cohen’s Kappa were calculated to compare the concordance of decisions between pairs of reviewers to test inter-rater reliability and convergent validity. The use of “overrides” and opinions of experts were recorded as measurements of content validity. Face validity was tested through collecting perspectives of nonprofessionals. Sensitivity, specificity, and predictive values were also reported. Results: There are 14 admission and 24 days of care criteria in the initial version of C-AEP. Kappa coefficients indicate substantial agreement between reviewers: with regard to inter-rater reliability, Kappa (κ) coefficients are 0.746 (95% confidence interval [CI] 0.644–0.834) and 0.743 (95% CI 0.698–0.767) of admission and hospital days, respectively; for convergent validity, the κ statistics are 0.678 (95% CI 0.567–0.778) and 0.691 (95% CI 0.644–0.717), respectively. Overrides account for less than 2% of all judgments. Content validity and face validity were confirmed by experts and nonprofessionals, respectively. According to the C-AEP reviewers, 18.3% of admissions and 28.5% of inpatient days were deemed inappropriate. Conclusions: The C-AEP is a reliable and valid screening tool in China’s tertiary hospitals. The prevalence of inappropriateness is substantial in our research. To reduce inappropriate utilization, further investigation is needed to elucidate the reasons and risk factors for this inappropriateness.

Suggested Citation

  • Wenwei Liu & Suwei Yuan & Fengqing Wei & Jing Yang & Zhe Zhang & Changbin Zhu & Jin Ma, 2015. "Reliability and Validity of the Chinese Version Appropriateness Evaluation Protocol," PLOS ONE, Public Library of Science, vol. 10(8), pages 1-11, August.
    • Handle: RePEc:plo:pone00:0136498
    DOI: 10.1371/journal.pone.0136498
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    References listed on IDEAS

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    1. Fontaine, Pierre & Jacques, Jessica & Gillain, Daniel & Sermeus, Walter & Kolh, Philippe & Gillet, Pierre, 2011. "Assessing the causes inducing lengthening of hospital stays by means of the Appropriateness Evaluation Protocol," Health Policy, Elsevier, vol. 99(1), pages 66-71, January.
    2. Buetow, Stephen A. & Sibbald, Bonnie & Cantrill, Judith A. & Halliwell, Shirley, 1997. "Appropriateness in health care: Application to prescribing," Social Science & Medicine, Elsevier, vol. 45(2), pages 261-271, July.
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    1. Wenwei Liu & Suwei Yuan & Fengqin Wei & Jing Yang & Jin Ma, 2018. "Inappropriate admissions of the cardiology and orthopedics departments of a tertiary hospital in Shanghai, China," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-12, December.

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