title: A pediatric appropriateness evaluation protocol for iran children hospitals.
abstract: BACKGROUND
  Applying utilization review programs is an appropriate solution to decrease the expenditure, and to increase the efficiency of healthcare systems.
  
  
  OBJECTIVE
  This paper presents an instrument to measure the level of appropriate admissions and days of stay (DOS) in the pediatric public hospitals of Iran.
  
  
  METHODS
  The American version of the Pediatric Appropriateness Evaluation Protocol (PAEP) was modified and adjusted by our group of physicians. They carried out a retrospective study over 100 randomly selected patients. The reliability of the instrument was tested based on the consensus of reviewers using PAEP. In addition, the external validity of the instrument was studied by comparing the evaluations of the reviewers using PAEP and the individual judgments of three clinicians in two public teaching hospitals. Finally, reliability and validity were also calculated by the kappa statistic.
  
  
  RESULTS
  With respect to the inter-reliability testing, there was a high level of agreement between reviewers applying the instrument in the admissions criteria and days of stay. Overall agreement was > 77%; also specific inappropriate agreement and specific appropriate agreement were > 61%, and > 72%, respectively. Regarding the validity of the testing, the instrument had a sensitivity of > 0.75, specificity of > 0.67, as well as positive and negative predictive values of > 0.93, and > 0.55, respectively. The kappa statistic for the reviewers (using the instrument for admission and days of stay criteria) were substantial (k = 0.75.5 and 0.71). They were also substantial for clinicians (k = 0.73 and 0.66).
  
  
  CONCLUSIONS
  These results showed that the modified PAEP is a reliable and valid instrument to study the appropriateness of admission and days of stay in Iran hospitals. As the developing countries, particularly, Middle East countries have the same status and culture, the result of this study (with minor changes) could be applied in these countries too.
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Anvar
authors.initials: A
authors.lastname: Esmaili
authors.affiliation: Health Management and Economics Research Centre, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Hesam
authors.initials: H
authors.lastname: Seyedin
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Obeidollah
authors.initials: O
authors.lastname: Faraji
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Jalal
authors.initials: J
authors.lastname: Arabloo
authors.affiliation: Mahabad Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IR Iran.
authors.forename: Yaghoub
authors.initials: Y
authors.lastname: Qahraman Bamdady
authors.affiliation: Mahabad Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IR Iran.
authors.forename: Shahin
authors.initials: S
authors.lastname: Shojaee
authors.affiliation: Mahabad Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, IR Iran.
authors.forename: Saadat
authors.initials: S
authors.lastname: Hesam
keywords: Hospital; Iran; Reliability; Validity