Hennessy Marita, Linehan Laura, Dennehy Rebecca, Devane Declan, Rice Rachel, Meaney Sarah, O'Donoghue Keelin
Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, T12 DC4A, Ireland.
INFANT Research Centre, University College Cork, Cork University Maternity Hospital, Cork, T12 DC4A, Ireland.
Res Involv Engagem. 2022 May 14;8(1):18. doi: 10.1186/s40900-022-00355-9.
Standardised care pathways tailored to women/couples who experience recurrent miscarriage are needed; however, clinical practice is inconsistent and poorly organised. In this paper, we outline our processes and experiences of developing guideline-based key performance indicators (KPIs) for recurrent miscarriage care with a diverse stakeholder group which will be used to evaluate national services. To date, such exercises have generally only involved clinicians, with the need for greater stakeholder involvement highlighted.
Our study involved six stages: (i) identification and synthesis of recommendations for recurrent miscarriage care through a systematic review of clinical practice guidelines; (ii) a two-round modified e-Delphi survey with stakeholders to develop consensus on recommendations and outcomes; (iii) four virtual meetings to develop this consensus further; (iv) development of a list of candidate KPIs; (v) survey to achieve consensus on the final suite of KPIs and a (vi) virtual meeting to agree on the final set of KPIs. Through participatory methods, participants provided feedback on the process of KPI development.
From an initial list of 373 recommendations and 14 outcomes, 110 indicators were prioritised for inclusion in the final suite of KPIs: (i) structure of care (n = 20); (ii) counselling and supportive care (n = 7); (iii) investigations (n = 30); treatment (n = 34); outcomes (n = 19). Participants' feedback on the process comprised three main themes: accessibility, richness in diversity, streamlining the development process.
It is important and feasible to develop guideline-based KPIs with a diverse stakeholder group. One hundred and ten KPIs were prioritised for inclusion in a suite of guideline-based KPIs for recurrent miscarriage care. Insights into our experiences may help others undertaking similar projects, particularly those undertaken in the absence of a clinical guideline and/or involving a range of stakeholders.
需要为经历反复流产的女性/夫妇量身定制标准化护理路径；然而，临床实践并不一致且组织不善。在本文中，我们概述了与不同利益相关者群体共同制定基于指南的反复流产护理关键绩效指标（KPI）的过程和经验，这些指标将用于评估国家服务。迄今为止，此类活动通常仅涉及临床医生，凸显了利益相关者更广泛参与的必要性。
我们的研究包括六个阶段：（i）通过对临床实践指南的系统回顾，识别和综合反复流产护理的建议；（ii）与利益相关者进行两轮改良的电子德尔菲调查，以就建议和结果达成共识；（iii）四次虚拟会议，进一步发展这种共识；（iv）制定候选KPI清单；（v）进行调查以就最终的KPI套件达成共识，以及（vi）召开虚拟会议以商定最终的KPI集。通过参与式方法，参与者对KPI制定过程提供了反馈。
从最初的373条建议和14项结果清单中，110项指标被优先纳入最终的KPI套件：（i）护理结构（n = 20）；（ii）咨询和支持性护理（n = 7）；（iii）检查（n = 30）；治疗（n = 34）；结果（n = 19）。参与者对该过程的反馈包括三个主要主题：可及性、多样性丰富、简化制定过程。
与不同利益相关者群体共同制定基于指南的KPI是重要且可行的。110项KPI被优先纳入一套基于指南的反复流产护理KPI中。对我们经验的深入了解可能有助于其他开展类似项目的人，特别是那些在没有临床指南和/或涉及一系列利益相关者的情况下开展的项目。
