Kenya Medical Research Institute/Wellcome Trust Centre for Geographic Medicine Research, Kilifi, Kenya.
BMC Pediatr. 2010 Dec 14;10:90. doi: 10.1186/1471-2431-10-90.
Indicators of quality of care for children in hospitals in low-income countries have been proposed, but information on their perceived validity and acceptability is lacking.
Potential indicators representing structural and process aspects of care for six common conditions were selected from existing, largely qualitative WHO assessment tools and guidelines. We employed the Delphi technique, which combines expert opinion and existing scientific information, to assess their perceived validity and acceptability. Panels of experts, one representing an international panel and one a national (Kenyan) panel, were asked to rate the indicators over 3 rounds and 2 rounds respectively according to a variety of attributes.
Based on a pre-specified consensus criteria most of the indicators presented to the experts were accepted: 112/137(82%) and 94/133(71%) for the international and local panels respectively. For the other indicators there was no consensus; none were rejected. Most indicators were rated highly on link to outcomes, reliability, relevance, actionability and priority but rated more poorly on feasibility of data collection under routine conditions. There was moderate to substantial agreement between the two panels of experts.
This Delphi study provided evidence for the perceived usefulness of most of a set of measures of quality of hospital care for children proposed for use in low-income countries. However, both international and local experts expressed concerns that data for many process-based indicators may not currently be available. The feasibility of widespread quality assessment and responsiveness of indicators to intervention should be examined as part of continued efforts to improve approaches to informative hospital quality assessment.
已经提出了用于衡量低收入国家医院中儿童护理质量的指标，但缺乏有关其感知有效性和可接受性的信息。
从现有的、主要是定性的世卫组织评估工具和指南中，选择了代表六种常见疾病护理的结构和过程方面的潜在指标。我们采用了德尔菲技术，该技术结合了专家意见和现有科学信息，以评估其感知的有效性和可接受性。一个国际小组和一个肯尼亚国内小组的专家小组分别进行了三轮和两轮评估，根据各种属性对指标进行评分。
根据预先规定的共识标准，向专家提出的大多数指标都得到了认可：国际小组和肯尼亚国内小组分别有 112/137（82%）和 94/133（71%）的指标得到认可。对于其他指标，没有达成共识；没有被否决的指标。大多数指标在与结果的关联性、可靠性、相关性、可操作性和优先级方面的评分较高，但在常规条件下收集数据的可行性方面的评分较低。两个专家小组之间存在中度至高度的一致性。
这项德尔菲研究为一套用于衡量低收入国家医院儿童护理质量的指标的感知有用性提供了证据。然而，国际和当地专家都表示担心，目前可能无法获得许多基于流程的指标的数据。应作为继续努力改进信息丰富的医院质量评估方法的一部分，检查广泛进行质量评估的可行性和指标对干预的反应性。
