Tsang P, Severs M P
Department of Medicine for Elderly People, Queen Alexandra Hospital, Portsmouth.
J R Coll Physicians Lond. 1995 Jul-Aug;29(4):311-4.
We studied the appropriateness of admissions to our acute geriatric unit to determine whether they were clinically indicated and to test the Appropriateness Evaluation Protocol (AEP), an instrument previously validated for general hospital admissions. An admission is appropriate according to the AEP if at least 1 of its 16 criteria is met. At the next ward round, a consultant would judge, given the clinical details available on admission, whether the admission was appropriate, regardless of the AEP. All emergency admissions during a three week period were eligible. Of 186 admissions, 146 (78.5%) were available for analysis. The rates of inappropriateness according to consultants and AEP were 13% and 11% respectively. The AEP had a sensitivity of 97%, specificity of 63%, positive and negative predictive values of 95% and 75% respectively. The overall agreement between consultants and AEP was 92% (kappa = 0.62). There are no data on the optimal level of appropriateness but our rate of 87% (89% using the AEP) appears favourable. This study also shows the AEP to be a suitable tool to monitor the appropriateness of acute geriatric admissions.
我们研究了入住我院急性老年病科的适宜性，以确定这些入住是否具有临床指征，并测试适宜性评估方案（AEP），这是一种先前已在综合医院入院评估中得到验证的工具。根据AEP，如果满足其16项标准中的至少1项，则入院是适宜的。在下一次病房查房时，会诊医生会根据入院时可得的临床细节判断入院是否适宜，而不考虑AEP。三周期间的所有急诊入院患者均符合条件。在186例入院患者中，有146例（78.5%）可供分析。会诊医生和AEP判断为不适宜的比例分别为13%和11%。AEP的灵敏度为97%，特异度为63%，阳性预测值和阴性预测值分别为95%和75%。会诊医生和AEP之间的总体一致性为92%（kappa = 0.62）。目前尚无关于适宜性最佳水平的数据，但我们87%的适宜率（使用AEP时为89%）似乎较为理想。本研究还表明，AEP是监测急性老年病科入院适宜性的合适工具。
