Department of Health Policy and Informatics, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
Department of Information Technology and Management, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
BMJ Paediatr Open. 2023 Nov;7(1). doi: 10.1136/bmjpo-2023-002209.
Few paediatric and perinatal quality indicators (QIs) have been developed in the Japanese setting, and the quality of care is not assured or validated. The aim of this study was to develop QIs in paediatric and perinatal care in Japan using an administrative database and confirm the feasibility and applicability of the indicators using a single-site practice test.
We used a RAND-modified Delphi method that integrates evidence review with expert consensus development. QI candidates were generated from clinical practice guidelines (CPGs) available in English or Japanese and existing QIs in nine selected paediatric or perinatal conditions. Consensus building was based on independent panel ratings. The performance of QIs was retrospectively assessed using data from an administrative database at the National Children's Hospital. Data between April 2018 and March 2019 were used, while data between April 2019 and March 2021 were also used for selected condition, considering the small number of patients. Each QI was calculated as follows: number of times the indicator was met/number of participants×100.
From the literature review conducted between 2010 and 2020, 124 CPGs and 193 existing indicators were identified to generate QI candidates. Through the consensus-building process, 133 QI candidates were assessed and 79 QIs were accepted. The practice test revealed wide variations in the process-level performance of QIs in four categories: patient safety: median 43.9% (IQR 16.7%-85.6%), general paediatrics: median 98.8% (IQR 84.2%-100%), advanced paediatrics: median 94.4% (IQR 46.0%-100%) and advanced obstetrics: median 80.3% (IQR 59.6%-100%).
We established 79 QIs for paediatric and perinatal care in Japan using an administrative database that can be applied to hospitals nationwide. The practice test confirmed the measurability of the developed QIs. Benchmarking these QIs will be an attractive approach to improving the quality of care.
在日本，很少有儿科和围产期质量指标（QIs）得到开发，并且护理质量也没有得到保证或验证。本研究的目的是使用管理数据库在日本开发儿科和围产期护理 QIs，并使用单站点实践测试确认指标的可行性和适用性。
我们使用 RAND 改良 Delphi 方法，该方法将证据审查与专家共识开发相结合。QI 候选者是从英语或日语的临床实践指南（CPGs）和九个选定的儿科或围产期疾病的现有 QI 中生成的。共识的形成是基于独立小组的评分。使用国家儿童医院管理数据库中的数据对 QI 的性能进行回顾性评估。使用 2018 年 4 月至 2019 年 3 月的数据，考虑到患者人数较少，还使用了 2019 年 4 月至 2021 年 3 月的数据。每个 QI 的计算方法如下：符合指标的次数/参与者人数×100。
从 2010 年至 2020 年进行的文献综述中，确定了 124 份 CPG 和 193 项现有指标，以生成 QI 候选者。通过共识建立过程，评估了 133 个 QI 候选者，接受了 79 个 QI。实践测试显示，四个类别中 QI 的过程水平表现存在广泛差异：患者安全：中位数 43.9%（IQR 16.7%-85.6%）、普通儿科：中位数 98.8%（IQR 84.2%-100%）、高级儿科：中位数 94.4%（IQR 46.0%-100%）和高级产科：中位数 80.3%（IQR 59.6%-100%）。
我们使用管理数据库在日本建立了 79 项儿科和围产期护理 QI，可以应用于全国范围内的医院。实践测试确认了开发的 QI 的可衡量性。基准这些 QI 将是提高护理质量的一种有吸引力的方法。
