Reliability of a German instrument to assess the appropriateness of hospital utilization in surgery

During the past years, the assessment of the appropriateness of hospital ut ilization has become increasingly important in the German health care syste m. Previous evaluations by regional review organizations in several states demonstrated the need for a standardized, reliable, and valid instrument to evaluate the appropriateness of inpatient care. Objective of the study is to test the reliability of a German adaptation of the "Appropriateness Eval uation Protocol" (AEP). Among all 2672 admissions from the department of su rgery of a regional medical center during one calendar year; 54 patients we re randomly selected to evaluate the inter-rater reliability and 51 patient s to test intra-rater reliability. Overall agreement, specific agreement an d Kappa statistics were estimated for every hospital admissions and all con secutive hospital days. The German AEP showed an inter-rater agreement of 7 4% (62-86%) for hospital admissions (Kappa = 0.44) and 84% (79%-88%) for al l hospital days (K = 0.55). Intra-rater reliability was 88% (79%-97%) for h ospital admissions (K = 0.60) and 88% (85%-92%) for all hospital days (K = 0.70). The observed agreement is independent of length of hospital stay and proportion of appropriate days. A standardized instrument with known metri c properties is essen tial for quality management in hospitals to prepare f or an increasingly consolidating health care market in Germany The German A EP is a reliable instrument, which will allow to identify inefficiencies in the management of surgical inpatients.