Development of Quality Metrics to Evaluate Pediatric Hematologic Oncology Care in the Outpatient Setting

There are currently no clinic-level quality of care metrics for outpatient pediatric oncology. We sought to develop a list of quality of care metrics for a leukemia-lymphoma (LL) clinic using a consensus process that can be adapted to other clinic settings. Medline-Ovid was searched for quality indicators relevant to pediatric oncology. A provisional list of 27 metrics spanning 7 categories was generated and circulated to a Consensus Group (CG) of LL clinic medical and nursing staff. A Delphi process comprising 2 rounds of ranking generated consensus on a final list of metrics. Consensus was defined as ≥70% of CG members ranking a metric within 2 consecutive scores. In round 1, 19 of 27 (70%) metrics reached consensus. CG members' comments resulted in 4 new metrics and revision of 8 original metrics. All 31 metrics were included in round 2. Twenty-four of 31 (77%) metrics reached consensus after round 2. Thirteen were chosen for the final list based on highest scores and eliminating redundancy. These included: patient communication/education; pain management; delay in access to clinical psychology, documentation of chemotherapy, of diagnosis/extent of disease, of treatment plan and of follow-up scheme; referral to transplant; radiation exposure during follow-up; delay until chemotherapy; clinic cancellations; and school attendance. This study provides a model of quality metric development that other clinics may use for local use. The final metrics will be used for ongoing quality improvement in the LL clinic.