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Global core indicators for measuring WHO's paediatric quality-of-care standards in health facilities: development and
Moise Muzigaba1, Tamar Chitashvili2, Allysha Choudhury3,4
1Department of Maternal, Newborn, Child, and Adolescent Health, and Ageing, World Health Organization, Avenue Appia 20, 1202, Geneva, Switzerland. muzigabam@who.int.
Insights
A new set of 25 core indicators was developed to monitor hospital care quality for children and adolescents globally. This framework supports progress tracking and improvement initiatives worldwide.
Area of Science:
- Healthcare Quality Improvement
- Pediatric Health Services Research
- Global Health Monitoring
Background:
- Lack of standardized global indicators for monitoring pediatric hospital care quality.
- Need for a parsimonious and robust set of indicators for routine or periodic measurement.
- Importance of indicators for progress tracking, accountability, learning, and improvement at multiple levels.
Purpose of the Study:
- To systematically prioritize and define a core set of indicators and their metadata for monitoring the quality of hospital care for children and young adolescents.
- To establish a framework for global and national progress tracking and quality improvement initiatives.
Main Methods:
- Deductive methodology using the World Health Organization Standards for improving the quality-of-care for children and young adolescents.
- Involved a rapid literature review, a systematic algorithm for indicator prioritization, and iterative expert consultations.
- Development of indicators and metadata based on 8 quality standards, 40 quality statements, and 520 quality measures.
Main Results:
- A robust set of 25 core indicators and their metadata was derived, covering all 8 WHO quality standards.
- The majority of indicators are process-related (64%), with 20% being outcome/impact indicators.
- Most indicators (84%) are proposed for measurement at both outpatient and inpatient levels.
Conclusions:
- The recommended indicators can be adopted using a tiered approach based on measurability and health information system readiness.
- Further research is needed to assess implementation feasibility across different contexts.
- Validation of these indicators for global common reporting is essential for widespread adoption.
Background:
There are currently no global recommendations on a parsimonious and robust set of indicators that can be measured routinely or periodically to monitor quality of hospital care for children and young adolescents. We describe a systematic methodology used to prioritize and define a core set of such indicators and their metadata for progress tracking, accountability, learning and improvement, at facility, (sub) national, national, and global levels.
Methods:
We used a deductive methodology which involved the use of the World Health Organization Standards for improving the quality-of-care for children and young adolescents in health facilities as the organizing framework for indicator development. The entire process involved 9 complementary steps which included: a rapid literature review of available evidence, the application of a peer-reviewed systematic algorithm for indicator systematization and prioritization, and multiple iterative expert consultations to establish consensus on the proposed indicators and their metadata.
Results:
We derived a robust set of 25 core indicators and their metadata, representing all 8 World Health Organization quality standards, 40 quality statements and 520 quality measures. Most of these indicators are process-related (64%) and 20% are outcome/impact indicators. A large proportion (84%) of indicators were proposed for measurement at both outpatient and inpatient levels. By virtue of being a parsimonious set and given the stringent criteria for prioritizing indicators with "quality measurement" attributes, the recommended set is not evenly distributed across the 8 quality standards.
Conclusions:
To support ongoing global and national initiatives around paediatric quality-of-care programming at country level, the recommended indicators can be adopted using a tiered approach that considers indicator measurability in the short-, medium-, and long-terms, within the context of the country's health information system readiness and maturity. However, there is a need for further research to assess the feasibility of implementing these indicators across contexts, and the need for their validation for global common reporting.
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