Department of Medicine, Sydvestjysk Sygehus Esbjerg, Finsensgade 35, DK-6700 Esbjerg, Denmark.
BMC Health Serv Res. 2011 Jun 27;11:152. doi: 10.1186/1472-6963-11-152.
To examine the prognostic significance of fulfilling at least one of the Appropriateness Evaluation Protocol (AEP) criteria.
Prospective observational cohort study at medical admission units at a regional teaching hospital in Denmark. 3,050 consecutively admitted patients were included, median age 66 (IQR: 50-77), 48% female.We assessed the fulfilment of the AEP criteria and mortality data, length of stay, readmissions and co-morbidity. We analyzed the association between day of admission and time of day and compared the opinion of the admitting doctors and nurses on the relevancy of admission.
61.9% of the patients fulfilled the AEP criteria. Patients fulfilling were older (p < 0.001), had a higher in-hospital mortality (p < 0.001), a higher 30-days mortality (p < 0.001), a longer length of stay (p < 0.001), more readmissions within 30 days (p < 0.001) and higher co-morbidity (p < 0.001). There were no association between day of admission and fulfilment of AEP criteria, but significantly fewer patients fulfilled the AEP criteria in the morning hours (p < 0.05). The nurses found 79.1% of the admissions relevant with a sensitivity of 84.8% and a specificity of 30.1% with a Kappa of 0.16. The doctors found 76.2% of the admissions relevant with a sensitivity of 86.4% and a specificity of 40.9% and a Kappa of 0.29.
Fulfilment of the AEP criteria adequately reflect increased morbidity and mortality of acutely admitted medical patients.
检查满足至少一个适宜性评估协议（AEP）标准的预后意义。
在丹麦一家地区教学医院的医疗入院单位进行前瞻性观察队列研究。共纳入 3050 名连续入院的患者，中位年龄 66（IQR：50-77），48%为女性。我们评估了 AEP 标准的满足情况和死亡率数据、住院时间、再入院和合并症。我们分析了入院日和时间与入院相关性的关系，并比较了入院医生和护士对入院相关性的看法。
61.9%的患者满足 AEP 标准。满足 AEP 标准的患者年龄较大（p < 0.001），住院死亡率较高（p < 0.001），30 天死亡率较高（p < 0.001），住院时间较长（p < 0.001），30 天内再入院率较高（p < 0.001），合并症较多（p < 0.001）。入院日与 AEP 标准的满足之间没有关联，但上午满足 AEP 标准的患者明显较少（p < 0.05）。护士发现 79.1%的入院与敏感度 84.8%、特异性 30.1%和 Kappa 值 0.16相关。医生发现 76.2%的入院与敏感度 86.4%、特异性 40.9%和 Kappa 值 0.29相关。
满足 AEP 标准充分反映了急性入院的医疗患者发病率和死亡率的增加。
