RAND Corporation, Pittsburgh, Pennsylvania.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Pediatrics. 2024 Jul 1;154(1). doi: 10.1542/peds.2024-065721.
OBJECTIVE: To elicit expert consensus on quality indicators for the hospital-based care of opioid-exposed infants. METHODS: We used the ExpertLens online platform to conduct a 3-round modified Delphi panel. Expert panelists included health care providers, parents in recovery, quality experts, and public health experts. We identified 49 candidate quality indicators from a literature review and environmental scan. A total of 32 experts rated the importance and feasibility of the indicators using a 9-point Likert scale (Round 1), reviewed and discussed the initial ratings (round 2), and revised their original ratings (Round 3). Numeric scores corresponded with descriptive ratings of "low" (1-3), "uncertain" (4-6), or "high" (7-9). We measured consensus using the RAND/UCLA Appropriateness Method. RESULTS: Candidate quality indicators assessed structures, processes, and outcomes in multiple domains of clinical care. After the final round, 36 indicators were rated "high" on importance and feasibility. Experts had strong consensus on the importance of quality indicators to assess universal screening of pregnant people for substance use disorder, hospital staff training, standardized assessment for neonatal opioid withdrawal syndrome, nonpharmacologic interventions, and transitions of care. For indicators focused on processes and outcomes, experts saw feasibility as dependent on the information routinely documented in electronic medical records or billing records. To present a more complete picture of hospital quality, experts suggested development of composite measures that summarize quality across multiple indicators. CONCLUSIONS: A panel of experts reached consensus on a range of quality indicators for hospital-based care of opioid-exposed infants, with potential for use in national benchmarking, intervention studies, or hospital performance measurement.
目的:就基于医院的阿片类药物暴露婴儿护理的质量指标征求专家共识。
方法:我们使用 ExpertLens 在线平台进行了 3 轮修改后的 Delphi 小组讨论。专家小组成员包括医疗保健提供者、康复中的父母、质量专家和公共卫生专家。我们从文献回顾和环境扫描中确定了 49 个候选质量指标。共有 32 名专家使用 9 分 Likert 量表对指标的重要性和可行性进行评分(第 1 轮),回顾和讨论初始评分(第 2 轮),并修订其原始评分(第 3 轮)。数值分数与“低”(1-3)、“不确定”(4-6)或“高”(7-9)的描述性评分相对应。我们使用 RAND/UCLA 适宜性方法衡量共识。
结果:候选质量指标评估了临床护理多个领域的结构、过程和结果。经过最后一轮,36 项指标在重要性和可行性方面均被评为“高”。专家们对评估孕妇物质使用障碍、医院员工培训、新生儿阿片类戒断综合征标准化评估、非药物干预和护理过渡的普遍筛查等质量指标的重要性达成了强烈共识。对于关注过程和结果的指标,专家们认为可行性取决于电子病历或计费记录中常规记录的信息。为了更全面地描述医院质量,专家们建议开发综合指标,以总结多个指标的质量。
结论:一组专家就基于医院的阿片类药物暴露婴儿护理的一系列质量指标达成了共识,这些指标有可能用于国家基准测试、干预研究或医院绩效衡量。
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