Paediatric Primary Care Centre, Regensburg, Germany.
European Association of Primary Care Paediatricians, ECPCP, Rheinhausen, Germany.
Eur J Pediatr. 2018 Jun;177(6):921-933. doi: 10.1007/s00431-018-3140-z. Epub 2018 Apr 14.
Paediatric ambulatory healthcare systems in Europe are, because of historical reasons, diverse and show strikingly different outcomes. All across Europe, the benchmarking of structures, processes and outcomes could reveal opportunities for improving Paediatric Primary Care (PPC). The aim of this study was to develop a set of Quality Indicators (QIs) to assess and monitor PPC in Europe. In a three-step process, we used the available external evidence and European expert consensus in a modified RAND/UCLA Appropriateness Method (RAM) to develop an indicator set. (1) A broad literature and online research of published QI and guidelines yielded an inventory of 1516 QI. (2) A collaborative panel of paediatric senior experts from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) from 15 European countries participated in a first consensus process to reduce the initial indicator inventory by eliminating not PPC-focused indicators and duplicates. (3) In a second consensus process, the panel rated the QI regarding validity and feasibility. The final QI set "COSI-PPC-EU" consists of 42 indicators in five categories of PPC: (A) health promotion/prevention/screening (13 QI), (B) acute care (9 QI), (C) chronic care (8 QI), (D) practice management (3 QI) and (E) patient safety (9 QI).
COSI-PPC-EU represents a consented set of a limited number of valid quality indicators for the application in paediatric primary care in different healthcare systems throughout Europe. What is Known: • Paediatric ambulatory healthcare systems in Europe are diverse and show strikingly different outcomes. • There are known gaps in quality performance measures of paediatric primary care in Europe. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care. What is New: • A set of 42 quality indicators for primary paediatric care in Europe was developed in a multi-country collaborative effort. The method combined a systematic literature review and a consensus process among European paediatric experts. • The quality indicator set can facilitate quality improvement of PPC. After studying the feasibility, providers can use COSI-PPC-EU to monitor, compare and improve performance of practices, regions and countries.
制定一套质量指标（QIs），以评估和监测欧洲的儿科初级保健（PPC）。
采用三步法，利用现有外部证据和欧洲专家共识，对改良后的 RAND/UCLA 适宜性方法（RAM）进行修改，制定指标集。（1）广泛查阅文献和在线研究已发表的 QI 和指南，生成了 1516 个 QI 的清单。（2）来自欧洲儿科学会（EAP）和欧洲初级保健儿科医生联合会（ECPCP）的 15 个欧洲国家的儿科高级专家合作小组参与了第一个共识过程，通过消除非 PPC 重点指标和重复指标，减少了初始指标清单。（3）在第二个共识过程中，小组对 QI 的有效性和可行性进行了评分。最终的 COSI-PPC-EU 质量指标集由 5 类 PPC 中的 42 个指标组成：（A）健康促进/预防/筛查（13 个 QI）、（B）急性护理（9 个 QI）、（C）慢性护理（8 个 QI）、（D）实践管理（3 个 QI）和（E）患者安全（9 个 QI）。
COSI-PPC-EU 代表了一套经过协商一致的、数量有限的有效质量指标，适用于欧洲不同医疗保健系统中的儿科初级保健。
• 欧洲的儿科门诊医疗系统因历史原因而多样化，结果差异显著。• 欧洲儿科初级保健的质量绩效衡量存在已知差距。现有的质量指标集主要局限于国家人口、特定疾病和医院护理。
• 采用多国合作的方式制定了一套欧洲儿科初级保健的 42 项质量指标。该方法结合了系统文献回顾和欧洲儿科专家共识。• 质量指标集可以促进 PPC 的质量改进。在研究了可行性之后，提供者可以使用 COSI-PPC-EU 来监测、比较和改进实践、地区和国家的绩效。
