Farida Helmia, Rondags Angelique, Gasem M Hussein, Leong Katharina, Adityana A, van den Broek Peterhans J, Keuter Monique, Natsch Stephanie
Department of Microbiology, Faculty of Medicine, Diponegoro University and Dr. Kariadi Hospital, Semarang, Indonesia.
Trop Med Int Health. 2015 Apr;20(4):501-9. doi: 10.1111/tmi.12452. Epub 2015 Jan 25.
To develop an instrument for evaluating the quality of antibiotic management of patients with community-acquired pneumonia (CAP) applicable in a middle-income developing country.
A previous study and Indonesian guidelines were reviewed to derive potential quality of care indicators (QIs). An expert panel performed a two-round Delphi consensus procedure on the QI's relevance to patient recovery, reduction of antimicrobial resistance and cost containment. Applicability in practice, including reliability, feasibility and opportunity for improvement, was determined in a data set of 128 patients hospitalised with CAP in Semarang, Indonesia.
Fifteen QIs were selected by the consensus procedure. Five QIs did not pass feasibility criteria, because of inappropriate documentation, inefficient laboratory services or patient factors. Three QIs provided minor opportunity for improvement. Two QIs contradicted each other; one of these was considered not valid and excluded. A final set of six QIs was defined for use in the Indonesian setting.
Using the Delphi method, we defined a list of QIs for assessing the quality of care, in particular antibiotic treatment, for CAP in Indonesia. For further improvement, a modified Delphi method that includes discussion, a sound medical documentation system, improvement of microbiology laboratory services, and multi-center applicability tests are needed to develop a valid and applicable QI list for the Indonesian setting.
开发一种适用于中等收入发展中国家的、用于评估社区获得性肺炎（CAP）患者抗生素管理质量的工具。
回顾一项先前的研究及印度尼西亚的指南，以得出潜在的医疗质量指标（QIs）。一个专家小组针对这些质量指标与患者康复、减少抗菌药物耐药性及控制成本的相关性进行了两轮德尔菲共识程序。在印度尼西亚三宝垄128例因CAP住院的患者数据集中，确定其在实际应用中的适用性，包括可靠性、可行性及改进机会。
通过共识程序选出了15个质量指标。5个质量指标未通过可行性标准，原因是记录不当、实验室服务效率低下或患者因素。3个质量指标提供的改进机会较小。2个质量指标相互矛盾；其中一个被认为无效并被排除。最终确定了一组6个质量指标用于印度尼西亚的情况。
通过德尔菲法，我们定义了一份用于评估印度尼西亚CAP患者医疗质量（尤其是抗生素治疗质量）的质量指标清单。为了进一步改进，需要一种包括讨论、完善的医疗记录系统、改进微生物学实验室服务以及多中心适用性测试的改良德尔菲法，以制定一份适用于印度尼西亚情况的有效且适用的质量指标清单。
