Jessica A. Schults RN, PhD , Karina R. Charles RN, MNurs PICU , Johnny Millar MBChB, PhD, MRCP, FRACP, FCICM , Claire M. Rickard RN, PhD , Vineet Chopra MD, MSc , Anna Lake RN, GradCertClinNurs , Kristen Gibbons PhD , Debbie Long RN, PhD , Sarfaraz Rahiman MD, FCICM , Katrina Hutching RN, MHlthLd , Jacinta Winderlich BNutDietet, MClinRes , Naomi E. Spotswood BMedSc, MBBS, MIPH, FRACP , Amy Johansen RN, MANP Research , Paul Secombe BA, DipAud, BMBS (Hons), MClinSc, FCICM , Georgina A. Pizimolas BPhty , Quyen Tu BPharm , Michaela Waak MBBS, MD , Meredith Allen MBBS, FRACP, FCICM, PhD, MSafSc , Brendan McMullan BMed (Hons), PhD , Lisa Hall BTech BiomedSci (Hons), PhD
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Pizimolas BPhty , Quyen Tu BPharm , Michaela Waak MBBS, MD , Meredith Allen MBBS, FRACP, FCICM, PhD, MSafSc , Brendan McMullan BMed (Hons), PhD , Lisa Hall BTech BiomedSci (Hons), PhD","doi":"10.1016/j.ccrj.2024.01.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Monitoring healthcare quality is challenging in paediatric critical care due to measure variability, data collection burden, and uncertainty regarding consumer and clinician priorities.</p></div><div><h3>Objective</h3><p>We sought to establish a core quality measure set that (i) is meaningful to consumers and clinicians and (ii) promotes alignment of measure use and collection across paediatric critical care.</p></div><div><h3>Design</h3><p>We conducted a multi-stakeholder Delphi study with embedded consumer prioritisation survey. The Delphi involved two surveys, followed by a consensus meeting. Triangulation methods were used to integrate survey findings prior tobefore the consensus meeting. 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引用次数: 0
摘要
引言在儿科危重症护理中,由于衡量标准的多变性、数据收集的负担以及消费者和临床医生优先考虑事项的不确定性,医疗质量监控具有挑战性。德尔菲研究包括两项调查,然后召开共识会议。在召开共识会议之前,我们使用三角测量法对调查结果进行了整合。会议邀请澳大利亚和新西兰的儿科危重症幸存者(18 岁)及其家属通过社交媒体和消费者团体发布的在线调查,对衡量标准的优先级进行排序。与此同时,还与儿科危重症护理临床医生、政策制定者和一名消费者代表进行了德尔菲研究。结果消费者调查的受访者(n = 117)将(i) 护患比例;(ii) 患者可视目标;(iii) 长期随访确定为其优先考虑的质量措施。在德尔菲过程中,临床医生(第一轮 n = 191;第二轮 n = 117 [61% 保留];第三轮 n = 14)和一名消费者代表就 51 个项目(占 83 个初始衡量标准的 61%)的核心衡量标准集达成了广泛一致。临床医生优先考虑的是:(i) 护患比例;(ii) 人员流动;(iii) 长期随访。由于缺乏标准化病例定义或数据收集负担,衡量标准的可行性较低。结论:我们为儿科危重症护理定义了一套 51 项的核心测量指标,符合临床医生和消费者的优先考虑。接下来的步骤是在质量计划中实施和进行方法评估,并在适当的情况下取消多余的测量项目。
Establishing a paediatric critical care core quality measure set using a multistakeholder, consensus-driven process
Introduction
Monitoring healthcare quality is challenging in paediatric critical care due to measure variability, data collection burden, and uncertainty regarding consumer and clinician priorities.
Objective
We sought to establish a core quality measure set that (i) is meaningful to consumers and clinicians and (ii) promotes alignment of measure use and collection across paediatric critical care.
Design
We conducted a multi-stakeholder Delphi study with embedded consumer prioritisation survey. The Delphi involved two surveys, followed by a consensus meeting. Triangulation methods were used to integrate survey findings prior tobefore the consensus meeting. In the consensus panel, broad agreement was reached on a core measure set, and recommendations were made for future measurement directions in paediatric critical care.
Setting and participants
Australian and New Zealand paediatric critical care survivors (aged >18 years) and families were invited to rank measure priorities in an online survey distributed via social media and consumer groups. A concurrent Delphi study was undertaken with paediatric critical care clinicians, policy makers, and a consumer representative.
Interventions
None.
Main outcome measures
Priorities for quality measures.
Results
Respondents to the consumer survey (n = 117) identified (i) nurse-patient ratios; (ii) visible patient goals; and (iii) long-term follow-up as their quality measure priorities. In the Delphi process, clinicians (Round 1 n = 191; Round 2 n = 117 [61% retention]; Round 3 n = 14) and a consumer representative reached broad agreement on a 51-item (61% of 83 initial measures) core measure set. Clinician priorities were (i) nurse-patient ratio; (ii) staff turnover; and (iii) long term-follow up. Measure feasibility was rated low due to a perceived lack of standardised case definitions or data collection burden. Five recommendations were generated.
Conclusion(s)
We defined a 51-item core measurement set for paediatric critical care, aligned with clinician and consumer priorities. Next steps are implementation and methodological evaluation in quality programs, and where appropriate, retirement of redundant measures.
期刊介绍:
ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines.
The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world.
The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.