Medical patients assessment protocol: a tool for evaluating the appropriateness of utilizing hospital-stay days for acute medical patients; development, reliability and applications.
An attempt was made to formulate a tool that, when compared to the appropriateness evaluation protocol (AEP) used for evaluating the utilization of hospital services for medical patients, would be an improvement. To establish this, a four-phase project was evolved, which included: (a) taxonomy definition of medical and nonmedical reasons for acute-care hospital bed utilization for a day of care, (b) use of the preliminary protocol by trained nurses to extend the range of clinical conditions included, (c) independent review of the protocol by three senior physicians, and (d) comparative interrater reliability and feasibility study between the new instrument-the medical patients assessment protocol (MPAP) and the AEP. We found the MPAP to have a higher inter-rater reliability than the AEP (kappa = 0.94 and 0.78, respectively), to be more clinically oriented, more comprehensive, and similar to the AEP regarding the time required for investigation of cases. Therefore, we recommend the use of the MPAP for management and quality control of medical hospitalized patients.
Mozes
B
B
Gertner Institute for Health Services Research, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Rosenblum
Y
Y
Rom
L
L
Friedman
N
N
Shabtai
E
E
Porat
A
A
D019090:Case Management / Q000458:organization & administration*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014600:Utilization Review / Q000379:methods*