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A Modified Delphi Study to Build Consensus on Pediatric-Specific Trauma Quality Indicators
Bailey K Roberts1, Brendan T Campbell2, Aaron R Jensen3
1Department of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA.
Insights
A modified Delphi method identified 52 pediatric trauma quality indicators (QI) to enhance care. These new and adapted QI will guide quality improvement and benchmarking in pediatric trauma centers.
Area of Science:
- Pediatric Trauma Care
- Quality Improvement Science
- Health Services Research
Background:
- Quality improvement (QI) efforts in pediatric trauma care have increased, driven by programs like the American College of Surgeons Pediatric Trauma Quality Improvement Program.
- A lack of consensus exists on specific quality indicators (QI) for measuring the quality of care in pediatric trauma patients.
- This study addresses the need for pediatric-specific trauma QI.
Purpose of the Study:
- To identify and define pediatric-specific quality indicators (QI) for trauma care.
- To establish a comprehensive list of QI to improve the quality of care for pediatric trauma patients.
- To inform quality improvement and benchmarking efforts in pediatric trauma centers.
Main Methods:
- An expert panel of pediatric trauma leaders was convened.
- A modified Delphi method was employed for virtual meetings and anonymous voting to define and refine potential QI.
- Prioritization of indicators was based on their importance for pediatric trauma care.
Main Results:
- Fourteen experts participated in the study.
- Following three rounds of voting and meetings, 52 QI were selected.
- These QI include 25 outcome, 21 process, and 6 structure variables across 6 quality domains, encompassing unique pediatric pathways, timeliness, injury prevention, and long-term outcomes.
Conclusions:
- A novel list of pediatric trauma QI was developed using a modified Delphi method.
- These QI are intended to guide quality improvement and benchmarking initiatives.
- Further analysis of outcomes is needed to validate the accuracy and utility of these indicators, serving as a foundation for national QI efforts.
Background:
Quality improvement efforts across pediatric trauma centers have expanded recently in large part because of the American College of Surgeons Pediatric Trauma Quality Improvement Program. However, consensus on quality indicators (QI) specific to pediatric trauma that measure "quality of care" in this population is lacking. This study aims to identify pediatric-specific trauma QI.
Study Design:
An expert panel of pediatric trauma leaders was convened. The panel met virtually to define and refine potential QI using a modified Delphi method, prioritizing indicators to include representing important QI for pediatric trauma. A comprehensive list of defined QI was created to improve the quality of pediatric trauma care.
Results:
14 experts were included in the panel. After 3 rounds of anonymous voting and meetings, 52 QI were chosen, including 25 outcome, 21 process, and 6 structure variables and spanning 6 domains of quality as defined by the Agency for Healthcare Research and Quality. Indicators comprised 22 unchanged from pTQIP, 10 adapted from currently reported in pTQIP, and 20 new. Indicators encompassed unique treatment pathways for pediatric patients, timeliness of care, screening and prevention of future injuries, and long-term outcomes.
Conclusion:
A modified Delphi method was used to develop a novel list of pediatric trauma QI to inform quality improvement and benchmarking efforts for pediatric trauma care. Analysis of outcomes is required to understand the accuracy and usefulness of these newly proposed and existing indicators. This study serves as a starting point for the incorporation of new QI within national quality improvement initiatives.
Study Type And Level Of Evidence:
Survey type study, level 4 evidence.
