Department of Health Informatics in the School of Public Health, Kyoto University, Kyoto, Japan.
Graduate School of Nursing Women's Health & Midwifery, School of Medicine Faculty of Nursing Department of Maternal Nursing, Nara Medical University, Kashihara, Japan.
BMJ Open. 2019 Feb 27;9(2):e023595. doi: 10.1136/bmjopen-2018-023595.
Quality indicators are measurable elements widely used to assess the quality of care. They are often developed from the results of systematic reviews or clinical practice guidelines. These sources are regularly updated in line with new clinical evidence, but there are few articles on updating quality indicators based on clinical practice guidelines. This study aimed to update the quality indicators developed for low-risk labour care in Japan in 2012, mainly drawing on new or updated clinical practice guidelines, and making the process clearly visible and assessable.
We used a modified Delphi method for the update. The procedure included four steps: (1) updating the definition of low-risk labour; (2) reviewing the literature published between June 2012 and December 2015 using five guidelines and two quality indicator databases to extract potential candidate indicators; (3) formation of a multidisciplinary panel including mothers and (4) panel ratings (two rounds between February and April 2016) on the validity of the candidate indicators, and judging the validity of the previous quality indicators drawing on the new evidence.
A multidisciplinary panel of 13 clinicians, including obstetricians, paediatricians and midwives, plus 3 non-clinician mothers.
The literature review identified 276 new recommendations from 27 clinical practice guidelines including 2 published in Japan and 21 quality indicators. We developed 13 new candidate indicators from these sources and panel recommendations, 12 of which were approved by the multidisciplinary panel. The panel also accepted all 23 existing quality indicators as still valid, resulting in a total of 35 quality indicators for low-risk labour.
We successfully updated the quality indicators for low-risk labour care in Japan. The procedure developed may be useful for updating other quality indicators based on new clinical practice guidelines.
质量指标是广泛用于评估医疗质量的可衡量要素。它们通常是根据系统评价或临床实践指南的结果制定的。这些来源会根据新的临床证据定期更新，但很少有文章涉及根据临床实践指南更新质量指标。本研究旨在主要依据新的或更新的临床实践指南更新 2012 年日本制定的低危分娩护理质量指标，并使该过程清晰可见且可评估。
我们使用改良 Delphi 方法进行更新。该程序包括四个步骤：（1）更新低危分娩的定义；（2）使用 5 项指南和 2 个质量指标数据库，检索 2012 年 6 月至 2015 年 12 月发表的文献，提取潜在的候选指标；（3）形成一个包括母亲在内的多学科小组；（4）于 2016 年 2 月至 4 月间进行小组投票（两轮），评估候选指标的有效性，并根据新证据判断先前质量指标的有效性。
一个由 13 名临床医生组成的多学科小组，包括产科医生、儿科医生和助产士，外加 3 名非临床医生的母亲。
文献综述从 27 项临床实践指南中确定了 276 项新建议，其中包括 2 项在日本发表的指南和 21 项质量指标。我们从这些来源和小组建议中制定了 13 项新的候选指标，其中 12 项得到了多学科小组的认可。小组还认为所有 23 项现有的质量指标仍然有效，因此，低危分娩护理的总质量指标共有 35 项。
我们成功地更新了日本低危分娩护理的质量指标。所开发的程序可能有助于根据新的临床实践指南更新其他质量指标。
