- Reliability and Validity of the Appropriateness Evaluation Protocol for Public Hospitals in Korea
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Clara Lee, Stella Jung-Hyun Kim, Changwoo Lee, Euichul Shin
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J Prev Med Public Health. 2019;52(5):316-322. Published online September 12, 2019
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DOI: https://doi.org/10.3961/jpmph.19.125
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 Abstract
Summary
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- Objectives
This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea.
Methods
In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared.
Results
The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively.
Conclusions
Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.
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Summary
Korean summary
이 연구는 우리나라 공공병원을 대상으로 Appropriateness Evaluation Protocol(AEP) 도구를 적용가능성을 검토하기 위해 실시되었다. 우리나라의 지역공공병원 입원자료(2016년 5월 기준)를 층화무작위추출을 통해 1,500건을 추출하였으며, 이중 37개 병원의 560건에 대해 입원적정성을 분석하였다. 의무기록사 2인은 AEP 도구를 이용하여 입원적정성을 각각 검토하였고, 의사 1인은 전문가적 판단을 기준으로 검토하였다. AEP 도구의 적용가능성을 판단하기 위해 의무기록사간 그리고 의무기록사-의사간 일치율을 산출하였다. 의무기록사간 일치율은 거의 완벽한 수준으로 나타났고, 의무기록사-의사간은 중등도의 일치율을 보였다. 민감도, 특이도는 각각 0.86 그리고 0.56이었다. 이러한 결과는 AEP 도구가 우리나라 공공병원의 입원적정성을 평가하기 위한 일관적이고 정확한 도구임을 제시한다.
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Citations
Citations to this article as recorded by  - Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study
Diego San Jose-Saras, Jorge Vicente-Guijarro, Paulo Sousa, Paloma Moreno-Nunez, Jesús María Aranaz-Andres, Cristina Díaz-Agero Pérez, Miguel Ignacio Cuchi Alfaro, Juan Manuel Ramos López, Mercedes García Haro, Abelardo Claudio Fernández Chávez, Cornelia B
BMC Medicine.2023;[Epub] CrossRef - Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach
D. San Jose-Saras, J. Vicente-Guijarro, P. Sousa, P. Moreno-Nunez, M. Espejo-Mambié, J. M. Aranaz-Andres
Journal of General Internal Medicine.2023; 38(7): 1655. CrossRef - Strategies to improve the flow of admissions and hospital stays: a Delphi study of an adaptation of the Appropriateness Evaluation Protocol (AEP)
A. Morillo-Rodríguez, S. Alonso-Fernández, J.M. Mòdol Deltell, B. Soldevila Madorell, Ll. Benito-Aracil, D. Parés
Revista Clínica Española (English Edition).2023; 223(5): 270. CrossRef - Estrategias para mejorar el flujo de ingresos y estancias hospitalarias: adaptación del cuestionario Appropriateness Evaluation Protocol (AEP): estudio Delphi
A. Morillo-Rodríguez, S. Alonso-Fernández, J.M. Mòdol Deltell, B. Soldevila Madorell, Ll. Benito-Aracil, D. Parés
Revista Clínica Española.2023; 223(5): 270. CrossRef
- Estimation of Disease Code Accuracy of National Medical Insurance Data and the Related Factors.
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Euichul Shin, Yong Mun Park, Yong Gyu Park, Byung Sung Kim, Ki Dong Park, Kwang Ho Meng
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Korean J Prev Med. 1998;31(3):471-480.
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Abstract
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- This study was undertaken in order to estimate the accuracy of disease code of the Korean National Medical Insurance Data and disease the characteristics related to the accuracy. To accomplish these objectives, 2,431 cases coded as notifiable acute communicable diseases (NACD) were randomly selected from 1994 National Medical Insurance data file and family medicine specialists reviewed the medical records to confirm the diagnostic accuracy and investigate the related factors. Major findings obtained from this study are as follows: 1. The accuracy rate of disease code of NACD in National Medical Insurance data was very low, 10.1% (95% C.I.: 8.8-11.4). 2. The reasons of inaccuracy in disease code were 1) claiming process related administrative error by physician and non-physician personnel in medical institutions (47.0%), 2) input error of claims data by key punchers of National Medical Insurer (31.3%) and 3) diagnostic error by physicians (21.7%). 3. Characteristics significantly related with lowering the accuracy of disease code were location and level of the medical institutions in multiple logistic regression analysis. Medical institutions in Seoul showed lower accuracy than those in Kyonngi, and so did general hospitals, hospitals and clinics than tertiary hospitals. Physician related characteristics significantly lowering disease code accuracy of insurance data were sex, age group and specialty. Male physicians showed significantly lower accuracy than female physicians; thirties and forties age group also showed significantly lower accuracy than twenties, and so did general physicians and other specialists than internal medicine/pediatric specialists. This study strongly suggests that a series of policies like 1) establishment of peer review organization of National Medical Insurance data, 2) prompt nation-wide expansion of computerized claiming network of National Medical Insurance and 3) establishment and distribution of objective diagnostic criteria to physicians are necessary to set up a national disease surveillance system utilizing National Medical Insurance claims data.
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Summary
- Health risks related to shift work among female workers of major manufacturing industries in Korea.
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Euichul Shin, Kwang Ho Meng
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Korean J Prev Med. 1991;24(3):279-286.
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Abstract
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- Much of the working population in developing countries are engaged in shift work now and the number of shift workers is not expected to decrease in the future mostly because the need for continuity of production is increasing. Therefore, the possible effects of shift work on health are of particular interest, and in fact, there have been many epidemiological studies on shift work since the first world war. However, no studies on health effects of shift work have been reported in Korea, and the existing studies in western world have arrived at quite different conclusions mainly because the conditions of work other than shift work, such as age and selection of workers, work environment, and labor conditions also influence the health of workers. This study was firstly carried out in Korea to investigate the health risks related to shift work with 2,093 female workers randomly selected from three major manufacturing industries in proportion to total number of female workers in those industries. Differences of work conditions other than shift work in this study were adjusted by multivariate analysis. Major findings obtained from this study are as follows: 1. There were significant differences between shift and day workers in the distribution of age, type of industry, condition of noise and dust, regularity of mealtime, working position, and working duration. Shift workers tended to be younger, to have shorter working duration, to have more irregular mealtime, to work in standing position, and to work under more noisy and dusty environment than day workers. 2. Univariate analysis showed that shift work increased the Todai Health Index (THI) scores of digestive tract, respiratory tract, and mental instability symptom categories. Shift work also increased days of sickness absence and number of industrial accident per 100 workers per month. 3. Multivariate analysis that adjusted the differences of demographic, occupational and non-occupational health-related working conditions showed that digestive tract symptoms and mental instability symptom scores were significantly higher in shift workers than those in day workers. Based on those study results, it is concluded that the shift work has significant effects on some psychophysiological conditions of the workers and the effects are also influenced by several other personal and working conditions.
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Summary
- Variation in resource utilization for inpatients among university teaching hospitals in city.
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Hayoung Park, Euichul Shin, Kwongho Meng
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Korean J Prev Med. 1990;23(4):451-464.
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Abstract
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- The variation in resource utilization for hospitalized patients who had a group of similar disease -- a Korean Diagnosis Related Group (KDRG) -- among the same type of hospitals was studied to assess the utilization variation due to the practice pattern of hospitals. Information about inpatients who were beneficiaries of the medical insurance for teachers and government officials discharged from 20 large university teaching hospitals in Seoul during 1986 and information about the hospitals were analyzed to achieve the study objective. A total of 20,223 non-outlier patients in 100 most frequent KDRGs were included in the analysis. Case charges after the review and length of stay (LOS) were used as measures of resource utilization during a hospitalization. A substantial variation among hospitals was found in most KDRGs: the ratio of the maximum and the minimum among the mean case charges of hospitals was greater than 2 in 83 KDRGs; the difference between the maximum and the minimum among the mean case charges of hospitals was greater than 100,000 Won in 94 KDRGs; the ratio of the maximum and the minimum among the mean LOS of hospitals was greater than 2 in 82 KDRGs; the difference between the maximum and the minimum among the mean LOS of hospitals was greater than 3 days in 94 KDRGs. The practice pattern of hospitals explained more than 20% of charge variation in 49 KDRGs and more than 20% of LOS variation in 43 KDRGs. The study results indicated need for a new health policy initiative for cost containment and quality assurance.
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