入院適當性工具AEP之信效度評估

To Evaluate an Admission Review Tool-the Reliability and Validity of AEP

溫信財(Hsyien-Chia Wen) ； 鐘國彪(Kuo-Piao Chung) ； 薛亞聖(Ya-Seng Hsueh) ； 楊志良(Chih-Liang Yaung) ； 季瑋珠(Wei-Chu Chie)

《台灣公共衛生雜誌》 20卷4期 (2001/08) Pp. 291-300

https://doi.org/10.6288/TJPH2001-20-04-05

摘要

目標：本研究目的評估mAEP(modified Appropriateness Evaluation Protocol)在國內使用之信度、效度及實用性，並嘗試了解國內不適當入院之主要原因。方法：研究設計是以三個月時間自健保台北、北區分局抽取申覆病歷426份，並以單盲技術(single bind technique)將影印病歷供本研究四位審查者(reviewers)以mAEP評估，最後再請總局醫審小組之各臨床專科醫師依其專業判斷入院之過當性，研究結果是以SPSS 10.0統計軟體分析。結果：本研究四位審查者中使用mAEP之一致性，有三位之kappa值為0.4左右，但在審查者計論並修正原判定後，kappa值增加為0.486-0.661，達到再現性佳(good reproducibility)之水準。在敏感度及特異度比較上，本研究最高值與分複審醫師之判定均在70%左右，顯示此部份在後續研究仍有相當改進空間。不適當入院原因以「任何診斷處置或（和）治療應可於門診完成」之比率最高，與國外研究相符。以mAEP審核病歷所花時間，平均值為2.6分鐘，與國外實證AEP為一簡易省時審查工具之結果相符。結論：本研究初步結果顯示mAEP在國內之信度、效度及實用性尚佳，mAEP若要成為健保局醫審及醫院入院之參考準則，須有後續研究進一步予以證實。

關鍵字

mAEP ； 信度 ； 效度 ； 實用性

並列摘要

Objectives: The purposes of our study are to evaluate the reliability, validity and practicality of mAEP (modified Appropriateness Evaluation Protocol) in Taiwan, and try to find the major reasons for Inappropriate admission. Methods: We collected 462 appeal claim medical records from Taipei and the Northern branch of the Bureau of National Health Insurance (BNHI). The copies of the medical records were dispensed by a single blind technique to 4 reviewers who used mAEP to judge the appropriateness of admission. Then the result was compared to the BNHI medical review physicians' judgement. The data was analyzed by SPSS 10.0 statistics software. Results: Three of the four reviewers' original Cohen's kappa were around 0.4. However, after reviewers discussion and revision of their appropriateness judgements. The kappa increased be tween 0.486 to 0.661. This represents a good reproducibility of mAEP. With regard to the sensitivity and specificity, the branch of BNHI medical review physicians and some of our reviewers were around 70%. Therefore, mAEP's validity still has room for improvement. The major reason for inappropriate admission is that the ”diagnostic procedures and/or treatment could be done on an outpatient basis”. This is the same as the studies in Western countires. The mean time to review the medical records with mAEP was 2.6 minutes. This is similar to Western studies and suggests that mAEP is a fast, easy and timesaving utilization review instrument. Conclusion: The preliminary result proved that the reliability, validity and practicality of mAEP are all good. However, if mAEP could become a tool for the BNHI's medical review and hospitals' admission protocol, further studies are needed.

並列關鍵字

reliability ； validity ； practicality ； modified Appropriateness Evaluation Protocol.