Department of Pediatrics, Division of Neonatology, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota.
Vermont Oxford Network, Burlington, Vermont.
Pediatrics. 2023 Sep 1;152(3). doi: 10.1542/peds.2023-061527.
Strategies to improve neonatal outcomes rely on accurate collection and analyses of quality indicators. Most low- and middle-income countries (LMICs) fail to monitor facility-level indicators, partly because recommended and consistently defined indicators for essential newborn care (ENC) do not exist. This gap prompted our development of an annotated directory of quality indicators.
We used a mixed method study design. In phase 1, we selected potential indicators by reviewing existing literature. An overall rating was assigned based on subscores for scientific evidence, importance, and usability. We used a modified Delphi technique for consensus-based approval from American Academy of Pediatrics Helping Babies Survive Planning Group members (phase 2) and secondarily surveyed international partners with expertise in ENC, LMIC clinical environments, and indicator development (phase 3). We generated the final directory with guidelines for site-specific indicator selection (phase 4).
We identified 51 indicators during phase 1. Following Delphi sessions and secondary review, we added 5 indicators and rejected 7. We categorized the 49 indicators meeting inclusion criteria into 3 domains: 17 outcome, 21 process, and 11 educational. Among those, we recommend 30 for use, meaning indicators should be selected preferentially when appropriate; we recommend 9 for selective use primarily because of data collection challenges and 10 for use with reservation because of scientific evidence or usability limitations.
We developed this open-access indicator directory with input from ENC experts to enable appraisal of care provision, track progress toward improvement goals, and provide a standard for benchmarking care delivery among LMICs.
提高新生儿结局的策略依赖于准确收集和分析质量指标。大多数中低收入国家（LMICs）未能监测机构层面的指标，部分原因是缺乏推荐的、一致定义的基本新生儿护理（ENC）质量指标。这一差距促使我们开发了一个带注释的质量指标目录。
我们采用混合方法研究设计。在第 1 阶段，我们通过审查现有文献选择潜在指标。根据科学证据、重要性和可用性的子分数对整体评分进行赋值。我们使用改良 Delphi 技术，由美国儿科学会帮助婴儿生存规划组（第 2 阶段）成员对指标进行基于共识的批准，并在第 3 阶段对在 ENC、LMIC 临床环境和指标开发方面具有专业知识的国际合作伙伴进行二次调查。我们根据特定地点的指标选择指南生成最终目录（第 4 阶段）。
在第 1 阶段，我们确定了 51 个指标。经过 Delphi 会议和二次审查，我们增加了 5 个指标，拒绝了 7 个指标。我们将符合纳入标准的 49 个指标分为 3 个领域：17 个结果、21 个过程和 11 个教育。其中，我们推荐使用 30 个指标，这意味着在适当的情况下应优先选择指标；我们推荐 9 个指标选择性使用，主要是因为数据收集的挑战，推荐 10 个指标使用时需要保留，这是因为科学证据或可用性有限。
我们在 ENC 专家的参与下开发了这个开放获取的指标目录，以评估护理服务的提供情况，跟踪朝着改善目标的进展，并为衡量 LMIC 之间的护理服务提供一个标准。
