Validation of a tool assessing appropriateness of hospital days in rehabilitation centres

Abstract

Objective: To develop and validate a list of objective criteria to assess the appropriateness of hospital days for patients admitted to rehabilitation centres and sub-acute care units.

Design: Sixteen appropriateness criteria were defined by a multidisciplinary panel of 33 experts using a formalized consensus method. A single ticked criterion classifies the hospital day as appropriate. Reliability was studied by measuring concordance between two independent and simultaneous ratings using the instrument. External validity was tested by comparing conclusions derived from the instrument with the individual judgements of one, two or three experts on the same random sample of hospital days.

Participants: The assessment on these criteria was performed on a randomized sample of 406 hospital days from 17 French wards.

Main outcome measures: Inter-rater reliability and external validity were evaluated using the kappa statistic and prevalence-adjusted and bias-adjusted kappa (PABAK).

Results: The inter-rater reliability test showed a kappa-value of 0.71 [95% confidence interval (95% CI) 0.63-0.78] and a PABAK of 0.77 (95% CI 0.70-0.83). There was a good agreement between the conclusions reached using the instrument and the individual judgements of experts with a kappa coefficient of 0.42 (95% CI 0.35-0.50) and a PABAK of 0.60 (95% CI 0.52-0.67).

Conclusions: The instrument is reliable and valid for assessing appropriateness of hospital days in rehabilitation centres and sub-acute care units. The next step in this study is the development of a tool for the analysis of causes of inappropriateness.