Broccoli Morgan C, Moresky Rachel, Dixon Julia, Muya Ivy, Taubman Cara, Wallis Lee A, Calvello Hynes Emilie J
Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA.
sidHARTe Program, Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, USA.
BMJ Glob Health. 2018 Feb 15;3(1):e000479. doi: 10.1136/bmjgh-2017-000479. eCollection 2018.
Facility-based emergency care delivery in low-income and middle- income countries is expanding rapidly, particularly in Africa. Unfortunately, these efforts rarely include measurement of the quality or the impact of care provided, which is essential for improvement of care provision. Our aim was to determine context-appropriate quality indicators that will allow uniform and objective data collection to enhance emergency care delivery throughout Africa. We undertook a multiphase expert consensus process to identify, rank and refine quality indicators. A comprehensive review of the literature identified existing indicators; those associated with a substantial burden of disease in Africa were categorised and presented to consensus conference delegates. Participants selected indicators based on inclusion criteria and priority clinical conditions. The indicators were then presented to a group of expert clinicians via on-line survey; all meeting agreements were refined in-person by a separate panel and ranked according to validity, feasibility and value. The consensus working group selected seven conditions addressing nearly 75% of mortality in the African region to prioritise during indicator development, and the final product at the end of the multiphase study was a list of 76 indicators. This comprehensive process produced a robust set of quality indicators for emergency care that are appropriate for use in the African setting. The adaptation of a standardised set of indicators will enhance the quality of care provided and allow for comparison of system strengthening efforts and resource distribution.
在低收入和中等收入国家，尤其是非洲，基于医疗机构的急诊护理服务正在迅速扩展。不幸的是，这些努力很少包括对所提供护理的质量或影响进行衡量，而这对于改善护理服务至关重要。我们的目标是确定适合具体情况的质量指标，以便进行统一和客观的数据收集，从而加强整个非洲的急诊护理服务。我们开展了一个多阶段的专家共识过程，以识别、排序和完善质量指标。对文献进行全面综述，确定现有的指标；将那些与非洲重大疾病负担相关的指标进行分类，并提交给共识会议的代表。参与者根据纳入标准和优先临床情况选择指标。然后通过在线调查将这些指标提交给一组专家临床医生；所有会议达成的共识由一个单独的小组进行现场完善，并根据有效性、可行性和价值进行排序。共识工作组选择了七种疾病状况，这些疾病导致了非洲地区近75%的死亡，以便在指标制定过程中确定优先次序，多阶段研究结束时的最终成果是一份包含76项指标的清单。这一全面的过程产生了一套适用于非洲环境的、强有力的急诊护理质量指标。采用一套标准化指标将提高所提供护理的质量，并便于比较系统强化工作和资源分配情况。
