入院及住院日适宜性评价方法在妇科和神经内科应用中的一致性研究

Agreement of appropriateness evaluation protocol of admission and hospital days in department of gynecology and department of neurology

目的探讨入院及住院日适宜性评价方法(AEP)在妇科和神经内科中应用的信度。方法在上海交通大学医学院附属仁济医院妇科和神经内科,各随机抽取50例入院患者的临床资料,由两名临床注册护士比照原始版本的AEP评估标准对患者的入院及住院日适宜性做回顾性研究,计算两名测评者间的一致性和Cohen's Kappa(κ)值,分析AEP评估对入院和住院服务适宜性的信度。同时,在住院适宜性判断中引入"校正(overrides)"选项,评估者根据其临床知识经验及现有诊疗水平做出与AEP评价相反的结果,提高AEP的灵活性。结果剔除数据不完整的病例后,两个科室各43份病例进入统计分析。基于AEP的入院评价结果,测评者间整体一致率为90.70%,κ值为0.59。基于AEP的住院日评价结果,测评者间整体一致率为77.52%,κ值为0.54;加入"校正"这一主观标准后,整体一致率为81.65%,κ值为0.61。结论原始版本的AEP在妇科和神经内科的应用过程中表现出较好的一致性。

Objective To investigate the agreement of appropriateness evaluation protocol （AEP） of admission and hospital days in department of gynecology and department of neurology. Methods The clinical data of 50 patients hospitalized in department of gynecology and 50 patients in department of neurology in Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine were randomly selected, and the appropriateness of admission and hospital （lays was retrospectively evaluated by two nurses based on AEP. The inter-rater agreement of two nurses and Cohen＇s Kappa （K） were calculated, and the agreement of AEP of admission and hospital days was determined. Meanwhile, the concept of ＂overrides＂ was introduced to increase the flexibility of AEP. Results After deletion of the incomplete data, 43 medical records from each department entered the statistical analysis. For the agreement of AEP-based judgment towards admission appropriateness, the overall agreement rate was 90.70%, and K was 0.59. For the inter-rater agreement of AEP-based judgment towards hospital days appropriateness, the overall agreement rate was 77.52%, and κ was 0.54. After introduction of ＂overrides＂, the inter-rater overall agreement rate was 81.65%, and K was 0.61. Conclusion Original AEP yields good agreement in assessment of the appropriateness of inpatient services in department of gynecology and department of neurology.