Overview of the Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy: A Joint NASPGHAN/ESPGHAN Guideline
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Published on: January 17, 2011
Catharine M Walsh1, Jenifer R Lightdale2, David R Mack3
1Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, Department of Paediatrics and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
Insights
Pediatric Endoscopy Quality Improvement Network (PEnQuIN) established international quality standards and indicators for pediatric endoscopy. These metrics aim to improve safety and quality of care for children undergoing endoscopic procedures.
Area of Science:
- Gastroenterology and Hepatology
- Pediatric Endoscopy
- Quality Improvement Science
Background:
- Need for pediatric-specific quality standards in endoscopy.
- Importance of measuring indicators for quality improvement.
- Development of best practices for pediatric gastrointestinal endoscopic procedures.
Purpose of the Study:
- To develop and define quality standards and indicators for pediatric gastrointestinal endoscopic procedures.
- To establish a framework for auditing, feedback, and benchmarking in pediatric endoscopy.
Main Methods:
- Utilized the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument.
- Employed an iterative online Delphi process followed by an in-person conference for consensus.
- Rated quality of evidence and strength of recommendations using the GRADE approach.
Main Results:
- Achieved consensus on 49 quality standards and 47 indicators covering facilities, procedures, endoscopists, and patient experience.
- The evidence base was primarily adult-based and observational, leading to "very low" quality ratings and "conditional" recommendations for most standards.
- 45 out of 49 standards received conditional recommendations.
Conclusions:
- The PEnQuIN process established international agreement on metrics for pediatric endoscopic care safety and quality.
- Provides a framework for pediatric endoscopists and services for performance auditing and benchmarking.
- Future research priorities include expanding the evidence base and prospectively validating PEnQuIN standards.
Introduction:
Pediatric-specific quality standards for endoscopy are needed to define best practices, while measurement of associated indicators is critical to guide quality improvement. The international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) working group was assembled to develop and define quality standards and indicators for pediatric gastrointestinal endoscopic procedures through a rigorous guideline consensus process.
Methods:
The Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument guided PEnQuIN members, recruited from 31 centers of various practice types representing 11 countries, in generating and refining proposed quality standards and indicators. Consensus was sought via an iterative online Delphi process, and finalized at an in-person conference. Quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach.
Results:
Forty-nine quality standards and 47 indicators reached consensus, encompassing pediatric endoscopy facilities, procedures, endoscopists, and the patient experience. The evidence base for PEnQuIN standards and indicators was largely adult-based and observational, and downgraded for indirectness, imprecision, and study limitations to "very low" quality, resulting in "conditional" recommendations for most standards (45/49).
Conclusions:
The PEnQuIN guideline development process establishes international agreement on clinically meaningful metrics that can be used to promote safety and quality in endoscopic care for children. Through PEnQuIN, pediatric endoscopists and endoscopy services now have a framework for auditing, providing feedback, and ultimately, benchmarking performance. Expansion of evidence and prospective validation of PEnQuIN standards and indicators as predictors of clinically relevant outcomes and high-quality pediatric endoscopic care is now a research priority.
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