A European version of the appropriateness evaluation protocol - Goals and presentation

This paper describes the development and testing of a European version of t he Appropriateness Evaulation Protocol (AEP). It stemmed from the original U.S. version and the multiple adaptations and modifications made previously and separately by researchers in European countries. The group was particu larly concerned with developing a common list of reasons for inappropriate admissions and days of stay, since the principal goal was to enable an unde rstanding of inappropriate hospital use and potential solutions within loca l health and social care systems. Developing a common EU-AEP included sever al steps. First, each national instrument was translated from the national language to English. These back translations were compared with each other and with the US-AEP. A working group analyzed the content of the lists of r easons published in the literature and proposed a novel conceptual approach . On the basis of workshop discussions, a draft of a common European versio n was circulated to each participant for agreement. In the EU-AEP, the clin ical criteria for the appropriateness of admission include 10 related to pa tient condition and five to clinical services. The criteria for the appropr iateness of days of care include 10 covering medical services, six for life support/nursing services, and eight related to patient condition. The prop osed core list of reasons of inappropriateness distinguish clearly between two concepts: a) the level of care required by the patient; and b) the reas on why this level of care was not used. The first list would thus refer to the nature of resources and facilities required, while the second would foc us more on the efficient organization of those resources. A validated Europ ean tool to assess inappropriate hospital admissions and hospital days of s tay and their causes might be used to assess the need for resources for inp atient care as well as for outpatient care. Assessing the reasons for inade quacies might lead also to the examination of organizational questions. Fin ally, a common tool allows comparisons between countries concerning the fre quency of inappropriate admissions and days of stay and their reasons in re lation to the different organizations of health care across Europe.