| 적절성 평가지침과 이유목록의 적용 가능성 평가 |
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| 신영수1, 김용익1, 김창엽1, 김윤1, 김은경2, 송윤미3, 이영성4 |
1서울대학교 의과대학 의료관리학교실
2서울대학교병원 QA 연구반
3단국대학교 의과대학 가정의학교실
4한국의료관리연구원 |
| Applicability of Appropriateness Evaluation Protocol and Delay Tool |
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| Youngsoo Shin1, Yong-Ik Kim1, Chang-Yup Kim1, Yoon Kim1, Eun Gyung Kim2, Yun Mi Song3, Young Seong Lee4 |
1Department of Health Policy and Management, College of Medicine, Seoul National University
2QA Office, Seoul National University Hospital
3Department of Family Medicine, College of Medicine, Dankook University
4Korea Institute of Health Services Management |
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| Abstract |
Background
An appropriate use of hospital beds can improve productivity of hospital significantly. The authors' previous study revealed that approximately one third of Korean hospital bed days and one sixth of admissions were inappropriately used, when it was measured by Appropriateness Evaluation Protocol(AEP) and Delay Tool modified into Korean situation by the authors. This study aims to evaluate applicability of the instruments in a new hospital. More specifically the study aims to measure appropriateness of the instruments used by newly trained nurse reviewers at a new hospital setting.
Methods
In order to evaluate applicability of these instruments, agreement rates of the scores recorded by newly trained nurse reviewers with by skilled nurse reviewer and also compared with the scores recorded by physician's implicit decision were assessed. Agreement rates were derived from concurrent application of AEP and Delay Tool to 52 admissions and 104 patient days from internal medicine, pediatrics, and general surgery of one university hospital. Overall agreement rate, specific nonacute agreement rate, and kappa statistics were used to indicate level of agreement.
Results
Overall agreement rates on appropriateness between newly trained nurse reviewers and skilled nurse reviewer were 100% in admission and 98% in bed days. Overall agreement rates on reason for inappropriateness between newly trained nurse reviewers and skilled nurse reviewer were 96% in admission and 91% in bed days. Overall agreement rates between newly trained nurse reviewers and physician reviewer were 86% in admission and 87% in bed days.
Conclusion
Results indicated that AEP and Delay Tool were applicable to a new hospital in detecting inappropriate utilization of beds and reasoning of the inappropriateness. These instruments could contribute to enhance efficiency of hospital use, through continuous monitoring of level of inappropriate hospital use at national or individual hospital level. |
| Key words
applicability;Appropriateness Evaluation Protocol;Delay Tool;hospital use; |
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