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Development of measures of the quality of emergency department care for children using a structured panel process
Astrid Guttmann1, Asma Razzaq, Patty Lindsay
1Institute for Clinical Evaluative Sciences, G Wing, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5. astrid.guttmann@ices.on.ca
Insights
Developing quality indicators for pediatric emergency care is crucial. This study defined 68 clinical indicators for 18 conditions, with 19 indicators calculated for 9 common pediatric emergency department visits.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Health Services Research
Background:
- Performance measures are vital for public reporting and quality improvement in healthcare.
- Currently, limited comprehensive measures exist for assessing the quality of pediatric emergency department (ED) services.
Purpose of the Study:
- To systematically develop evidence-based and expert-endorsed measures for pediatric ED care (ages 0-19).
- Measures aim to cover common conditions, link processes to outcomes, and be feasible for data collection.
Main Methods:
- A panel of healthcare providers and managers identified common pediatric ED conditions.
- A literature review and structured panel process were used to define process-outcome links and select indicators.
- Feasibility was assessed using administrative data from Ontario, Canada.
Main Results:
- The panel identified 18 clinical conditions and 61 process-outcome links.
- 68 specific clinical indicators were defined for conditions including asthma, mental health, and infections.
- 19 indicators covering 9 conditions, representing 20% of pediatric ED visits, were calculable from administrative data.
Conclusions:
- A structured process successfully defined indicators for pediatric emergency care.
- The feasibility of implementing these quality measures depends on the availability of high-quality administrative data.
Background:
Performance measures are essential components of public reporting and quality improvement. To date, few such measures exist to provide a comprehensive assessment of the quality of emergency department services for children.
Objectives:
Our goal was to use a systematic process to develop measures of emergency department care for children (0-19 years) that are (1) based on research evidence and expert opinion, (2) representative of a range of conditions treated in most emergency departments, (3) related to links between processes and outcomes, and (4) feasible to measure.
Methods:
We presented a panel of providers and managers data from emergency department use to identify common conditions across levels of patient acuity, which could be targets for quality improvement. We used a structured panel process informed by a literature review to (1) identify condition-specific links between processes of care and defined outcomes and (2) select indicators to assess these process-outcome links. We determined the feasibility of calculating these indicators using an administrative data set of emergency department visits for Ontario, Canada.
Results:
The panel identified 18 clinical conditions for indicator development and 61 condition-specific links between processes of care and outcomes. After 2 rounds of ratings, the panel defined 68 specific clinical indicators for the following conditions: adolescent mental health problems, ankle injury, asthma, bronchiolitis, croup, diabetes, fever, gastroenteritis, minor head injury, neonatal jaundice, seizures, and urinary tract infections. Visits for these conditions account for 23% of all pediatric emergency department use. Using an administrative data set, we were able to calculate 19 indicators, covering 9 conditions, representing 20% of all emergency department visits by children.
Conclusions:
Using a structured panel process, data on emergency department use, and literature review, it was possible to define indicators of emergency department care for children. The feasibility of these indicators will depend on the availability of high-quality data.
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