title: Developing of the appropriateness evaluation protocol for public hospitals in iran.
abstract: BACKGROUND
  Employment of utilization review instruments is a method for managing costs and efficiency in the healthcare systems.
  
  
  OBJECTIVE
  This study developed an instrument for measuring the level of inappropriate acute hospital admissions and days of care in Iran.
  
  
  METHODS
  The American version of the Appropriateness Evaluation Protocol (AEP) was modified, using the agreement method, by a multidisciplinary group of physicians. We conducted a retrospective descriptive study of 273 randomly selected patients admitted to Imam Khomeini Hospital of Tehran University of Medical Sciences in Tehran, Iran. For the reliability study, two nurses were asked to review patients' medical records using the instrument. Validity was appraised by pairs of clinicians, including two general surgeons, two internists and two gynecologists. The degree of consensus between the three pairs of clinicians was compared with that of the nurses.
  
  
  RESULTS
  Inter-rater and intra-rater reliability testing revealed an excellent level of consensus between the two nurses employing the AEP in all the studied departments. Overall agreement was > 92%, while the specific appropriate agreement and specific inappropriate agreement were > 88% and > 83%, respectively. External validity testing of the instrument yielded a sensitivity > 0.785, specificity > 0.55, and positive and negative predictive values > 0.775 and > 0.555, respectively. The kappa statistic for the nurses who applied the AEP and clinicians using personal judgment were perfect (k > 0.85) and substantial (k > 0.68), respectively.
  
  
  CONCLUSIONS
  The results illustrate that the Iranian version of the AEP (IR-AEP) could be a reliable and valid instrument for assessing the level of inappropriate acute hospital admissions and days of care in the Iranian context.
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: Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Ravaghi
authors.affiliation: Health Management and Economics Research Centre, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Hesam
authors.initials: H
authors.lastname: Seyedin
authors.affiliation: Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Bahram
authors.initials: B
authors.lastname: Delgoshaei
authors.affiliation: Health Management and Economics Research Centre, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Salehi
keywords: Appropriateness Review; Clinical Protocols; Iran; Reliability and Validity