Design and validation of revised medication assessment tool for community-acquired Pneumonia: rMAT-CAP
Abstract
Background: Evaluating therapeutic appropriateness is a cornerstone of antimicrobial stewardship. The original Medication Assessment Tool for Community-Acquired Pneumonia (MAT-CAP), developed in Norway, requires adaptation to account for evolving IDSA/ATS recommendations and region-specific antimicrobial resistance patterns in the UAE. To revise, adapt, and validate a Medication Assessment Tool for Community-Acquired Pneumonia (rMAT-CAP), adapted to the UAE healthcare context.
Methods: A methodological study was conducted in three phases: (1) systematic revision of MAT-CAP indicators in accordance with 2019 IDSA/ATS guidelines and UAE resistance data; (2) content validation through a multidisciplinary Delphi panel of 10 experts; and (3) psychometric validation using inter-rater reliability and criterion validity assessments based on 30 anonymized CAP cases.
Results: The rMAT-CAP comprised 13 explicit, guideline-aligned criteria covering empirical therapy, microbiological diagnostics, dose adjustment, IV-to-oral switch, and treatment duration. Content validity indices were excellent (mean I-CVI = 0.95; S-CVI/Ave = 0.95). Inter-rater reliability demonstrated almost perfect agreement for the drug domain (κ = 0.87; absolute agreement 90.0%, 95% CI: 73.5-97.9%), substantial agreement for the dose domain (κ = 0.64; absolute agreement 73.3%, 95% CI: 54.1-86.6%), and moderate agreement for the duration domain (κ = 0.45; absolute agreement 80.0%, 95% CI: 61.4-91.1%). Criterion…
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