住院適當性評估表（AEP）修訂版在臺灣之應用

Application of a Modified Appropriateness Evaluation Protocol in Taiwan

全民健康保險實施以來，醫療院所對於醫療審查執行與健保局間有非常大的爭議，而國內目前尚無許多臨床醫療參考基準，本研究想了解經歐美多國證實信度、效度之入院及住院日適當性評量準則（appropriateness evaluation protocol，AEP），可否做為國內評量入院及住院日適當性之工具。首先自健保總局及六個分局依分層隨機抽取三十位審查醫師，以德菲法評量AEP之適用性及可行性，再召開專家座談會，以促成審查醫師一致之看法。由審核醫師會議討論德菲法評量所得結果後，刪除靜脈給藥及肌肉注射抗生素二項，另修改脈博、血壓等五項基準（criteria），最後完成入院及住院日適當性評量準則修訂版（Modified AEP）之工作。本研究後續將進一步評估AEP修訂後在國內使用之信度、效度，及了解國內不適當入院及住院日之原因，並嘗試做跨國性之比較。

Although the National Health Insurance (NHI) program has been implemented in Taiwan for many years, many hospitals are still unsatisfied with the appropriateness of peer review results. At the same time, there are few clinical protocols available in Taiwan. This study aimed fedetermine the feasiblity of the Appropriateness Evaluation Protocol (AEP), which has been shown to be a reliable and valid tool for peer review by US and European countries. We selected 30 medical review physicians by stratified sampling from the Bureau of NHI, and used the Delphi technique to collect their ratings and commonts on the feasibility of AEP and medical record availability in Taiwan. In order to reach the consensus, we also invited these physicians for a panel discussion. According to the results of the AEP's feasibility review and panel discussion, we deleted parenteral therapy and intramuscular injection criteria, and revised five criteria.