Evaluation of the appropriateness of hospital care in internal medicine: Reliability of a German adaptation of the "Appropriateness Evaluation Protocol".

Background and objective: The evaluation of the appropriateness of hospital admissions and hospital stays has become an increasingly important issue i n Germany. Evaluations by the German Physicians Review Organizations (MDS, MDK) demonstrated the need for a standardized, valid and reliable assessmen t tool for inappropriate hospital use. Objective of this study was to test the reliability of a German adaptation of the >>Appropriateness Evaluation Protocol<< (AEP). Patients and Methods: From the 2317 admissions to medical wards of a teachi ng hospital in Hessia in 1997 we randomly selected 52 patients to test the inter-rater-reliability (54% female, mean age=66 years +/- 18). Another 49 patients were randomly selected to test the intra-rater-reliability of the AEP (53% female, mean age=61 years +/- 20). We estimated general agreement, specific agreement a nd Kappa statistics for the agreement of the evaluati on of hospital admissions and hospital days. 95% confidence intervals were reported. Results: The German adaptation of the AEP showed an inter-rater-agreement o f 92% (88-96%) for hospital admissions and 76% (73-80%) for hospital days. Correspondingly, we observed an intra-rater-agreement of 96% (88-100%) for hospital admissions and 93% (91-95%) for hospital days. The high agreement was independent of the length of hospital stay and independent of the propo rtion of inappropriate hospital days. Conclusion: A standard instrument for the assessment of the appropriateness of hospital care with known metric properties may be useful for quality ma nagement in hospitals and provide competitive advantages in a consolidating health care market. The AEP could be such an instrument.