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Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopy Facilities:
Jenifer R Lightdale1, Catharine M Walsh2, Priya Narula3
1Department of Pediatrics, Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, MA, United States.
Insights
International standards for pediatric endoscopy facilities were developed to ensure high-quality care. The Pediatric Endoscopy Quality Improvement Network (PEnQuIN) created 27 standards and 10 indicators for assessing facility quality and improving patient outcomes.
Area of Science:
- Pediatric Gastroenterology
- Healthcare Quality Improvement
- Endoscopy Facility Standards
Background:
- Variability in endoscopy facility standards impacts procedural quality and patient outcomes.
- Assessing endoscopy facility quality at regional and national levels is increasingly recognized as crucial for improvement.
Purpose of the Study:
- To develop standardized quality indicators for pediatric endoscopy facilities.
- To establish benchmarks for high-quality endoscopic care in children.
Main Methods:
- Utilized the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II methodology.
- Employed an international working group from the Pediatric Endoscopy Quality Improvement Network (PEnQuIN).
- Achieved consensus through an iterative online Delphi process and an in-person meeting, with evidence and recommendations rated using the GRADE approach.
Main Results:
- Developed 27 consensus standards and 10 indicators for pediatric endoscopy facilities.
- Standards are categorized into Quality of Clinical Operations (15 standards, 5 indicators), Patient and Caregiver Experience (9 standards, 5 indicators), and Workforce (3 standards).
Conclusions:
- The PEnQuIN process successfully generated universal standards and indicators for guiding and measuring high-quality pediatric endoscopy facilities globally.
- Highlighted the need for further research into pediatric endoscopic care processes due to current evidence gaps.
Introduction:
There is increasing international recognition of the impact of variability in endoscopy facilities on procedural quality and outcomes. There is also growing precedent for assessing the quality of endoscopy facilities at regional and national levels by using standardized rating scales to identify opportunities for improvement.
Methods:
With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of facilities where endoscopic care is provided to children. Consensus was reached via an iterative online Delphi process and subsequent in-person meeting. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach.
Results:
The PEnQuIN working group achieved consensus on 27 standards for facilities supporting pediatric endoscopy, as well 10 indicators that can be used to identify high-quality endoscopic care in children. These standards were subcategorized into three subdomains: Quality of Clinical Operations (15 standards, 5 indicators); Patient and Caregiver Experience (9 standards, 5 indicators); and Workforce (3 standards).
Discussion:
The rigorous PEnQuIN process successfully yielded standards and indicators that can be used to universally guide and measure high-quality facilities for procedures around the world where endoscopy is performed in children. It also underscores the current paucity of evidence for pediatric endoscopic care processes, and the need for research into this clinical area.
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