Braithwaite Jeffrey, Hibbert Peter D, Jaffe Adam, White Les, Cowell Christopher T, Harris Mark F, Runciman William B, Hallahan Andrew R, Wheaton Gavin, Williams Helena M, Murphy Elisabeth, Molloy Charlotte J, Wiles Louise K, Ramanathan Shanthi, Arnolda Gaston, Ting Hsuen P, Hooper Tamara D, Szabo Natalie, Wakefield John G, Hughes Clifford F, Schmiede Annette, Dalton Chris, Dalton Sarah, Holt Joanna, Donaldson Liam, Kelley Ed, Lilford Richard, Lachman Peter, Muething Stephen
Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Centre for Population Health Research, Sansom Institute for Health Research, The University of South Australia, Adelaide, South Australia, Australia.
JAMA. 2018 Mar 20;319(11):1113-1124. doi: 10.1001/jama.2018.0162.
The quality of routine care for children is rarely assessed, and then usually in single settings or for single clinical conditions.
To estimate the quality of health care for children in Australia in inpatient and ambulatory health care settings.
DESIGN, SETTING, AND PARTICIPANTS: Multistage stratified sample with medical record review to assess adherence with quality indicators extracted from clinical practice guidelines for 17 common, high-burden clinical conditions (noncommunicable [n = 5], mental health [n = 4], acute infection [n = 7], and injury [n = 1]), such as asthma, attention-deficit/hyperactivity disorder, tonsillitis, and head injury. For these 17 conditions, 479 quality indicators were identified, with the number varying by condition, ranging from 9 for eczema to 54 for head injury. Four hundred medical records were targeted for sampling for each of 15 conditions while 267 records were targeted for anxiety and 133 for depression. Within each selected medical record, all visits for the 17 targeted conditions were identified, and separate quality assessments made for each. Care was evaluated for 6689 children 15 years of age and younger who had 15 240 visits to emergency departments, for inpatient admissions, or to pediatricians and general practitioners in selected urban and rural locations in 3 Australian states. These visits generated 160 202 quality indicator assessments.
Quality indicators were identified through a systematic search of local and international guidelines. Individual indicators were extracted from guidelines and assessed using a 2-stage Delphi process.
Quality of care for each clinical condition and overall.
Of 6689 children with surveyed medical records, 53.6% were aged 0 to 4 years and 55.5% were male. Adherence to quality of care indicators was estimated at 59.8% (95% CI, 57.5%-62.0%; n = 160 202) across the 17 conditions, ranging from a high of 88.8% (95% CI, 83.0%-93.1%; n = 2638) for autism to a low of 43.5% (95% CI, 36.8%-50.4%; n = 2354) for tonsillitis. The mean adherence by condition category was estimated as 60.5% (95% CI, 57.2%-63.8%; n = 41 265) for noncommunicable conditions (range, 52.8%-75.8%); 82.4% (95% CI, 79.0%-85.5%; n = 14 622) for mental health conditions (range, 71.5%-88.8%); 56.3% (95% CI, 53.2%-59.4%; n = 94 037) for acute infections (range, 43.5%-69.8%); and 78.3% (95% CI, 75.1%-81.2%; n = 10 278) for injury.
Among a sample of children receiving care in Australia in 2012-2013, the overall prevalence of adherence to quality of care indicators for important conditions was not high. For many of these conditions, the quality of care may be inadequate.
儿童常规护理的质量很少得到评估，而且通常是在单一环境或针对单一临床病症进行评估。
评估澳大利亚住院和门诊医疗环境中儿童的医疗保健质量。
设计、地点和参与者：采用多阶段分层抽样，并进行病历审查，以评估对从17种常见的、高负担临床病症（非传染性疾病[n = 5]、心理健康疾病[n = 4]、急性感染疾病[n = 7]和伤害疾病[n = 1]）的临床实践指南中提取的质量指标的遵循情况，如哮喘、注意力缺陷多动障碍、扁桃体炎和头部损伤。针对这17种病症，确定了479项质量指标，指标数量因病症而异，从湿疹的9项到头部损伤的54项不等。针对15种病症中的每一种，目标是抽取400份病历样本，而焦虑症抽取267份病历样本，抑郁症抽取133份病历样本。在每份选定的病历中，识别出针对17种目标病症的所有就诊情况，并对每种情况进行单独的质量评估。对澳大利亚3个州选定的城市和农村地区15岁及以下的6689名儿童进行了护理评估，这些儿童共进行了15240次急诊就诊、住院治疗或看儿科医生和全科医生。这些就诊产生了160202次质量指标评估。
通过系统检索当地和国际指南来确定质量指标。从指南中提取各个指标，并使用两阶段德尔菲法进行评估。
每种临床病症以及总体的护理质量。
在6689名接受调查病历的儿童中，53.6%的儿童年龄在0至4岁之间，55.5%为男性。在这17种病症中，护理质量指标的遵循率估计为59.8%（95%置信区间，57.5%-62.0%；n = 160202），从自闭症的88.8%（95%置信区间，83.0%-93.1%；n = 2638）到扁桃体炎的43.5%（95%置信区间，36.8%-50.4%；n = 2354）不等。按病症类别划分的平均遵循率估计为：非传染性疾病为60.5%（95%置信区间，57.2%-63.8%；n = 41265）（范围为52.8%-75.8%）；心理健康疾病为82.4%（95%置信区间，79.0%-85.5%；n = 14622）（范围为71.5%-88.8%）；急性感染疾病为56.3%（95%置信区间，53.2%-59.4%；n = 94037）（范围为43.5%-69.8%）；伤害疾病为78.3%（95%置信区间，75.1%-81.2%；n = 10278）。
在2012 - 2013年澳大利亚接受护理的儿童样本中，重要病症护理质量指标的总体遵循率不高。对于其中许多病症，护理质量可能不足。
