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Pediatric Appropriate Evaluation Protocol for India (PAEP-India): Tool for Assessing Appropriateness of Pediatric Hospitalization

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Abstract

Objectives

To develop and assess Pediatric Appropriateness Evaluation Protocol for India (PAEP-India) for inter-rater reliability and appropriateness of hospitalization.

Design

Cross-sectional study.

Setting

The available PAEP tools were reviewed and adapted for Indian context by ten experienced pediatricians following semi-Delphi process. Two PAEP-India tools; newborn (≤28 days) and children (>28 days-18 years) were developed. These PAEP-India tools were applied to cases to assess appropriateness of admission and inter-rater reliability between assessors.

Participants

Two sets of case records were used: (i) 274 cases from five medical colleges in Delhi-NCR [≤28 days (n=51); >28 days to 18 years (n=223)]; (ii) 622 infants who were hospitalized in 146 health facilities and were part of a cohort (n= 30688) from two southern Indian states.

Interventions

Each case-record was evaluated by two pediatricians in a blinded manner using the appropriate PAEPIndia tools, and ‘admission criteria’ were categorized as appropriate, inappropriate or indeterminate.

Main outcome measures

The proportion of appropriate hospitalizations and inter-rater reliability between assessors (using kappa statistic) were estimated for the cases.

Results

97.8% hospitalized cases from medical colleges were labelled as appropriate by both reviewers with inter-rater agreement of 98.9% (k=0.66). In the southerm Indian set of infants, both reviewers labelled 80.5% admissions as appropriate with inter-rater agreement of 96.1% (k= 0.89).

Conclusions

PAEP-India (newborn and child) tools are simple, objective and applicable in diverse settings and highly reliable. These tools can potentially be used for deciding admission appropriateness and hospital stay and may be evaluated later for usefulness for cost reimbursements for insurance proposes.

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References

  1. Ministry of Health and Family Welfare, Government of India. Ayushman Bharat Yojana (2018–2022). Government of India; 2018. Available from: https://www.pradhan mantriyojana.in/ayushman–bharat–yojana/. Accessed March 26, 2018.

  2. Ministry of Health and Family Welfare, Government of India. National Health Policy, 2017. Government of India; 2017. Available from: https://mohfw.gov.in/sites/default/files/9147562941489753121.pdf. Accessed July 19, 2017.

  3. National Health Systems Resource Centre. National Health Accounts Estimates for India (2013–14). Ministry of Health and Family Welfare Government of India; 2016. Available from:https://mohfw.gov.in/sites/default/files/89498311 221471416058.pdf. Accessed July 19, 2017.

  4. Planning Commission (Government of India). Report of the Working Group on Tertiary Care Institutions for 12th Five Year Plan 2012–2017. Government of India; 2011. Available from: http://planningcommission.nic.in/aboutus/committee/wrkgrp12/health/WG_2tertiary.pdf. Accessed July 19, 2017.

  5. Ortiga B, Salazar A, Jovell A, Escarrabill J, Marca G, Corbella X. Standardizing admission and discharge processes to improve patient flow: A cross sectional study. BMC Health Serv Res. 2012;12:180.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Strumwasser I, Paranjpe NV, Ronis DL, Share D, Sell LJ. Reliability and validity of utilization review criteria. Appropriateness evaluation protocol, standardized medreview instrument, and intensity–severity–discharge criteria. Med Care. 1990;28:95–111.

    CAS  PubMed  Google Scholar 

  7. Kemper KJ, Fink HD, McCarthy PL. The reliability and validity of the pediatric appropriateness evaluation protocol. QRB Qual Rev Bull. 1989;15:77–80.

    Article  CAS  PubMed  Google Scholar 

  8. McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharmacy. 2016;38:655–62.

    Google Scholar 

  9. Werneke U, Smith H, Smith IJ, Taylor J, MacFaul R. Validation of the paediatric appropriateness evaluation protocol in British practice. Arch Dis Child. 1997;77:294–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Esmail A. Development of the paediatric appropriateness evaluation protocol for use in the United Kingdom. J Public Health Med. 2000;22:224–30.

    Article  CAS  PubMed  Google Scholar 

  11. Esmaili A, Seyedin H, Faraji O, Arabloo J, Qahraman Bamdady Y, Shojaee S, et al. A pediatric appropriateness evaluation protocol for Iran children hospitals. Iran Red Crescent Med J. 2014;16:e16602.

    Article  Google Scholar 

  12. Smith HE, Sheps S, Matheson DS. Assessing the utilization of in–patient facilities in a Canadian pediatric hospital. Pediatrics. 1993;92:587–93.

    CAS  PubMed  Google Scholar 

  13. Gloor JE, Kissoon N, Joubert GI. Appropriateness of hospitalization in a Canadian pediatric hospital. Pediatrics. 1993;91:70–4.

    CAS  PubMed  Google Scholar 

  14. Henley L, Smit M, Roux P, Zwarenstein M. Bed use in the medical wards of Red Cross War Memorial Children’s Hospital, Cape Town. S Afr Med J. 1991;80:487–90.

    CAS  PubMed  Google Scholar 

  15. Shafik MH, Seoudi TMM, Raway TS, Al Harbash NZ, Ahmad MMA, Al Mutairi HF. Appropriateness of pediatric hospitalization in a general hospital in Kuwait. Med Princ Pract. 2012;21:516–21.

    Article  PubMed  Google Scholar 

  16. Kreger BE, Restuccia JD. Assessing the need to hospitalize children: Pediatric appropriateness evaluation protocol. Pediatrics. 1989;84:242–7.

    CAS  PubMed  Google Scholar 

  17. Werneke U, MacFaul R. Evaluation of appropriateness of paediatric admission. Arch Dis Child. 1996;74:268–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Bianco A, Pileggi C, Trani F, Angelillo IF. Appropriateness of admissions and days of stay in pediatric wards of Italy. Pediatrics. 2003;112:124–8.

    Article  PubMed  Google Scholar 

  19. Formby DJ, McMullin ND, Danagher K, Oldham DR. The appropriateness evaluation protocol: application in an Australian children’s hospital. Aust Clin Rev. 1991;11:123–31.

    CAS  PubMed  Google Scholar 

  20. Black RE, Morris SS, Bryce J. Where and why are 10 million children dying every year? Lancet. 2003;361: 2226–34.

    Article  PubMed  Google Scholar 

  21. Agarwal R, Deorari A, Paul VK. AIIMS Protocols in Neonatology. 1st ed. New Delhi: CBS Publishers; 2015.

    Google Scholar 

  22. National Neonatology Forum, India. Evidence based clinical practice guidelines. National Neonatology Forum; 2010. Available from: http://www.nnfi.org/. Accessed July 19, 2017.

  23. Ministry of Health and Family Welfare, Government of India. Facility based new born care training packages. Government of India; 2014. Available from: http://nhm.gov.in/nrhm–components/rmnch–a/child–healthimmunization/child–health/guidelines.html. Accessed April 16, 2016.

  24. World Health Organization. Global Advisory Committee on Vaccine Safety, 15–16 June 2016. Wkly Epidemiol Rec. 2016;91:341–8.

    Google Scholar 

  25. Cohen J. A Coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.

    Article  Google Scholar 

  26. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  CAS  Google Scholar 

  27. Feinstein AR, Cicchetti DV. High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol. 1990;43:543–9.

    Article  CAS  PubMed  Google Scholar 

  28. Cicchetti DV, Feinstein AR. High agreement but low kappa: II. Resolving the paradoxes. J Clin Epidemiol. 1990;43:551–8.

    Article  CAS  PubMed  Google Scholar 

  29. Chakravarty A, Parmar N, Bhalwar R. Inappropriate use of hospital beds in a tertiary care service hospital. Med J Armed Forces India. 2005;61:121–4.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kanwar V, Salaria N, Khanduja P. How do nurses perceive hospital bed utilization: A prerequisite for quality improvement in nursing care. Int J Health Sci Res. 2014;4135–41.

    Google Scholar 

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Authors and Affiliations

  1. The INCLEN Trust International, Okhla Industrial Area, Phase I, New Delhi, Departments of Pediatrics, New Delhi, India

    Manoja Kumar Das, Narendra Kumar Arora & Ramesh Poluru

  2. Lady Hardinge Medical College, New Delhi, India

    Anju Seth

  3. University College of Medical Sciences, New Delhi, India

    Anju Aggarwal

  4. Maulana Azad Medical College, New Delhi, India

    Anand Prakash Dubey

  5. North DMC Medical College and Hindu Rao Hospital, New Delhi, India

    Pc Goyal

  6. Pt BD Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India

    Geeta Gathwala

  7. Jawahar Lal Nehru Medical College, Aligarh Muslim University, Aligarh, UP, India

    Ashraf Malik

  8. All India Institute of Medical Sciences, Raipur, Chhattisgarh, India

    Anil Kumar Goel

  9. Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India

    Aparna Chakravarty

  10. Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India

    Sugandha Arya

  11. LLRM Medical College Meerut, Uttar Pradesh, India

    Amit Upadhyay

  12. WHO Country office India, New Delhi, India

    Madhur Gupta

  13. Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India

    Thomas Mathew

  14. Government Medical College, Thiruvananthapuram, Kerala, India

    Rajamohanan K Pillai

  15. PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

    John Mathai, Sivamani Manivasagan & S Ramesh

  16. Ministry of Health and Family Welfare, Government of India, New Delhi, India

    Mahesh Kumar Aggarwal

  17. World Health Organization, Geneva, Switzerland, India

    Chsirtine G Maure & Patrick Lf Zuber

  18. The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110 020, India

    Manoja Kumar Das

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  1. Manoja Kumar Das
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  2. Narendra Kumar Arora
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  4. Anju Seth
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  8. Geeta Gathwala
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  19. S Ramesh
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  20. Mahesh Kumar Aggarwal
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  21. Chsirtine G Maure
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Corresponding author

Correspondence to Manoja Kumar Das.

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Das, M.K., Arora, N.K., Poluru, R. et al. Pediatric Appropriate Evaluation Protocol for India (PAEP-India): Tool for Assessing Appropriateness of Pediatric Hospitalization. Indian Pediatr 55, 1041–1045 (2018). https://doi.org/10.1007/s13312-018-1438-6

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  • DOI: https://doi.org/10.1007/s13312-018-1438-6

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