title: Reliability and Validity of the Chinese Version Appropriateness Evaluation Protocol.
abstract: OBJECTIVE
  To adapt the Appropriateness Evaluation Protocol (AEP) to the specific settings of health care in China and to validate the Chinese version AEP (C-AEP).
  
  
  METHODS
  Forward and backward translations were carried out to the original criteria. Twenty experts participated in the consultancy to form a preliminary version of the C-AEP. To ensure applicability, tests of reliability and validity were performed on 350 admissions and 3,226 hospital days of acute myocardial infraction patients and total hip replacement patients in two tertiary hospitals by two C-AEP reviewers and two physician reviewers. Overall agreement, specific agreement, and Cohen's Kappa were calculated to compare the concordance of decisions between pairs of reviewers to test inter-rater reliability and convergent validity. The use of "overrides" and opinions of experts were recorded as measurements of content validity. Face validity was tested through collecting perspectives of nonprofessionals. Sensitivity, specificity, and predictive values were also reported.
  
  
  RESULTS
  There are 14 admission and 24 days of care criteria in the initial version of C-AEP. Kappa coefficients indicate substantial agreement between reviewers: with regard to inter-rater reliability, Kappa (κ) coefficients are 0.746 (95% confidence interval [CI] 0.644-0.834) and 0.743 (95% CI 0.698-0.767) of admission and hospital days, respectively; for convergent validity, the κ statistics are 0.678 (95% CI 0.567-0.778) and 0.691 (95% CI 0.644-0.717), respectively. Overrides account for less than 2% of all judgments. Content validity and face validity were confirmed by experts and nonprofessionals, respectively. According to the C-AEP reviewers, 18.3% of admissions and 28.5% of inpatient days were deemed inappropriate.
  
  
  CONCLUSIONS
  The C-AEP is a reliable and valid screening tool in China's tertiary hospitals. The prevalence of inappropriateness is substantial in our research. To reduce inappropriate utilization, further investigation is needed to elucidate the reasons and risk factors for this inappropriateness.
authors: Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai, China.
authors: Wenwei
authors: W
authors: Liu
authors: School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
authors: Suwei
authors: S
authors: Yuan
authors: School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
authors: Fengqing
authors: F
authors: Wei
authors: Department of Medical Administration, Shanghai Rui Jin Hospital, Shanghai, China.
authors: Jing
authors: J
authors: Yang
authors: School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
authors: Zhe
authors: Z
authors: Zhang
authors: Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Changbin
authors: C
authors: Zhu
authors: School of Public Health, Shanghai Jiao Tong University, Shanghai, China.
authors: Jin
authors: J
authors: Ma
mesh_terms: D002681:China; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D010820:Physicians; D015203:Reproducibility of Results