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Development of a quality improvement audit tool for the primary care of children with chronic wet cough using a
Samantha J Prime1, Julie Marchant1,2, Anne B Chang1,2,3
1Centre for Children's Health Research, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
Insights
Experts reached full consensus on 10 quality indicators (QIs) for managing chronic wet cough in children. These QIs can now guide primary care quality improvement initiatives.
Area of Science:
- Pediatric Respiratory Medicine
- Primary Health Care Quality
- Clinical Audit
Background:
- There is a lack of established quality indicators (QIs) for managing chronic wet cough in children.
- Effective primary care management before referral is crucial for pediatric respiratory health.
Purpose of the Study:
- To achieve expert consensus on QIs for primary care of children with chronic wet cough.
- To establish indicators reflecting good quality care prior to referral.
Main Methods:
- A 10-item QI questionnaire was developed based on current evidence and guidelines.
- A modified Delphi consensus method was used with pediatric respiratory and general pediatric specialists.
- Consensus was defined as >75% agreement on indicator importance.
Main Results:
- Twenty-two specialists participated, bringing extensive respiratory and general pediatric experience.
- Complete consensus was achieved on all 10 proposed QIs.
- Six QIs achieved 100% agreement, with a mean agreement of 97% across all items.
Conclusions:
- The high level of consensus supports the use of these QIs as a provisional clinical audit tool.
- These QIs can inform the development of a robust audit tool for primary care.
- The indicators facilitate quality improvement initiatives in pediatric chronic wet cough management.
Aim:
In the absence of quality indicators (QIs) for the management of chronic wet cough, our study's aim was to determine whether consensus on QIs reflecting good primary health care, prior to referral for children with chronic wet cough, can be achieved.
Methods:
A questionnaire consisting of 10 QIs was developed by a clinical working group based on current evidence and guidelines on the management of chronic wet cough in children. Each indicator reflected the quality of care provided to children with chronic wet cough in primary care prior to referral. A modified Delphi consensus questionnaire was undertaken involving expert paediatric respiratory clinicians and general paediatricians who graded the importance of each indicator for the purposes above. We a priori defined that consensus was considered achieved if >75% agreed on the indicator.
Results:
Twenty-two specialists (from Brisbane, Melbourne, Perth and Canberra) participated in the survey. The cumulative number of years of their respiratory experience was 324 and that of general clinical practice was 504. Consensus was achieved in all 10 QIs, with 6 reaching 100% agreement. Mean agreement for the 10 items was 97%.
Conclusion:
As complete consensus was achieved on these QIs, it can be used as a provisional clinical audit tool and can guide the development of a robust audit tool for primary care clinical practice to assist with quality improvement initiatives.
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