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Moving Toward Standardized Pediatric Performance Improvement Measures in Child Physical Abuse: A Modified Delphi
Todd Nickoles1, Jodie Greenberg, LeAnne Young
1Phoenix Children's Hospital, Phoenix, Arizona (Mr Nickoles and Ms Greenberg); Memorial Hospital South Bend, South Bend, Indiana (Ms Young); C.S. Mott Children's Hospital, Ann Arbor, Michigan (Ms Randall); Children's Hospital St Louis, St Louis, Missouri (Ms Herndon); Children's Hospital of Los Angeles, Los Angeles, California (Ms Bautista Durand); Boston Children's Hospital, Boston, Massachusetts (Ms McMahon); and EGAN School of Nursing and Health Studies, Fairfield University, Fairfield, Connecticut (Dr Roney).
Background:
Limited guidance exists for pediatric trauma centers (PTCs) regarding best practice for measuring and reviewing performance improvement (PI) in the child physical abuse population. To move PTC programs toward standardized guidelines and PI practices, current practice and points of consensus among level 1 and 2 PTCs across the United States were assessed.
Methods:
Utilizing a two-round, modified Delphi methodology, electronic surveys were distributed to pediatric trauma program managers and coordinators representing 125 PTCs. Survey data included demographics, coding practices, definitions, current PI measures, prevention programs, and opinions regarding key components of child physical abuse guidelines.
Results:
In Round 1, responses were received from 90 (72%) PTCs [47 (84%) ACS-verified level 1 PTCs; 29 (73%) ACS-verified level 2 PTCs; and 14 (48%) state PTCs]. Of the respondents, 87% agreed that establishing a national consensus for child physical abuse PI is important, and 92% agreed that their institution would benefit from standardized guidelines. Although PI process varied among PTCs in terms of measures, review, and coding practices, several points of consensus were achieved.
Conclusion:
Survey results demonstrate areas of consistency and a foundation for consensus among PTCs. Results also identify areas of practice diversity that may benefit from an attempt to standardize PI across centers.
