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Development of paediatric quality of inpatient care indicators for low-income countries - A Delphi study
Stephen Ntoburi1, Andrew Hutchings, Colin Sanderson
1Kenya Medical Research Institute/Wellcome Trust Centre for Geographic Medicine Research, Kilifi, Kenya. sntoburi@nairobi.kemri-wellcome.org
Insights
This study assessed the validity and acceptability of hospital quality of care indicators for children in low-income countries. Most proposed indicators were accepted by international and national experts, though data collection feasibility remains a concern.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Global Health
Background:
- Quality of care indicators for hospitalized children in low-income countries are needed but lack validation.
- Perceived validity and acceptability data for these indicators are scarce.
Purpose of the Study:
- To assess the perceived validity and acceptability of proposed hospital quality of care indicators for children in low-income countries.
- To gather expert consensus on structural and process indicators for common childhood conditions.
Main Methods:
- Utilized the Delphi technique with international and national (Kenyan) expert panels.
- Experts rated potential indicators on attributes like validity, acceptability, and feasibility over multiple rounds.
- Indicators were selected from existing World Health Organization (WHO) assessment tools and guidelines.
Main Results:
- High acceptance rates for indicators: 82% by the international panel and 71% by the national panel.
- Indicators generally rated well for outcome linkage, reliability, relevance, actionability, and priority.
- Lower ratings were given for the feasibility of data collection under routine conditions.
- Moderate to substantial agreement was observed between the international and national expert panels.
Conclusions:
- The Delphi study supports the perceived usefulness of many proposed quality of care indicators for children in low-income settings.
- Experts raised concerns regarding the current availability of data for many process-based indicators.
- Further research should examine the feasibility of indicator implementation and responsiveness to interventions for improved hospital quality assessment.
Background:
Indicators of quality of care for children in hospitals in low-income countries have been proposed, but information on their perceived validity and acceptability is lacking.
Methods:
Potential indicators representing structural and process aspects of care for six common conditions were selected from existing, largely qualitative WHO assessment tools and guidelines. We employed the Delphi technique, which combines expert opinion and existing scientific information, to assess their perceived validity and acceptability. Panels of experts, one representing an international panel and one a national (Kenyan) panel, were asked to rate the indicators over 3 rounds and 2 rounds respectively according to a variety of attributes.
Results:
Based on a pre-specified consensus criteria most of the indicators presented to the experts were accepted: 112/137(82%) and 94/133(71%) for the international and local panels respectively. For the other indicators there was no consensus; none were rejected. Most indicators were rated highly on link to outcomes, reliability, relevance, actionability and priority but rated more poorly on feasibility of data collection under routine conditions. There was moderate to substantial agreement between the two panels of experts.
Conclusions:
This Delphi study provided evidence for the perceived usefulness of most of a set of measures of quality of hospital care for children proposed for use in low-income countries. However, both international and local experts expressed concerns that data for many process-based indicators may not currently be available. The feasibility of widespread quality assessment and responsiveness of indicators to intervention should be examined as part of continued efforts to improve approaches to informative hospital quality assessment.
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