Development of quality indicators based on a multidisciplinary, evidence-based guideline on pediatric constipation

Several clinical guidelines for childhood functional constipation have been developed, but none of them is accompanied by a set of quality indicators. It is important to gain insight into the quality of care in daily practice in order to improve the implementation of clinical guidelines. This can be done by developing and measuring quality indicators. We identified a set of quality indicators for diagnosis and treatment of children with functional constipation, based on the existing Dutch evidence-based multidisciplinary guideline 'Functional constipation in children between 0 and 18 years' and expert opinions of professionals and patients. Assessment of the initial 84 potential quality indicators was done by using a RAND-modified Delphi method. The final set consisted of seven representative quality indicators (one structure and six process quality indicators) for children with functional constipation, covering the dimensions of diagnosis, medical treatment, non-medical treatment and referral. This study describes a systematic method to develop a set of seven process and structure quality indicators that can be used to monitor quality of health care for children with functional constipation.