Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Canada.
Joe Di Maggio Children's Hospital, Memorial Health System, 1150 N 35 Ave, Suite 555, Hollywood, FL, 33021, USA.
Pediatr Surg Int. 2024 Nov 6;40(1):292. doi: 10.1007/s00383-024-05870-2.
The Global Assessment for Pediatric Surgery (GAPS) tool was developed to enhance pediatric surgical care in Low- and Middle-Income Countries. This study presents the addition of a capacity-based weighting system to the GAPS tool.
GAPS, developed through a multi-phase process including systematic review, international testing, item analysis, and refinement, assesses 64 items across 5 domains: human resources, material resources, education, accessibility, and outcomes. This new weighting system differentially weighs each domain. The GAPS Score was evaluated using pilot study data, focusing on hospital and country income levels, human development index, under-five mortality rate, neonatal mortality rate, deaths due to injury and deaths due to congenital anomalies. Analysis involved the Kruskal-Wallis test and linear regression. Benchmark values for the GAPS overall score and subsection scores were identified.
The GAPS score's capacity-based weighting system effectively discriminated between levels of hospital (p = 0.0001) and country income level (p = 0.002). The GAPS scores showed significant associations with human development index (p < 0.001) and key health indicators such as under-five mortality rates (p < 0.001), neonatal mortality rate (p < 0.001), and deaths due to injury (p < 0.001). Benchmark scores for the GAPS overall score and the subsection scores included most institutions within their respective hospital level.
The GAPS tool and score, enhanced with the capacity-based weighting system, marks progress in assessing pediatric surgical capacity in resource-limited settings. By mirroring the complex reality of hospital functionality in low-resource centers, it provides a refined mechanism for fostering effective partnerships and data-driven strategic interventions.
全球儿科外科学评估（GAPS）工具旨在加强中低收入国家的儿科外科护理。本研究在 GAPS 工具中增加了基于能力的加权系统。
GAPS 通过包括系统评价、国际测试、项目分析和改进的多阶段过程开发，评估了 5 个领域的 64 个项目：人力资源、物质资源、教育、可及性和结果。这个新的加权系统对每个领域进行了不同的加权。使用试点研究数据评估了 GAPS 评分，重点关注医院和国家收入水平、人类发展指数、五岁以下儿童死亡率、新生儿死亡率、因伤害导致的死亡和因先天异常导致的死亡。分析涉及 Kruskal-Wallis 检验和线性回归。确定了 GAPS 总分和子项得分的基准值。
GAPS 评分的基于能力的加权系统能够有效地区分医院水平（p=0.0001）和国家收入水平（p=0.002）。GAPS 评分与人类发展指数显著相关（p<0.001），并与关键健康指标如五岁以下儿童死亡率（p<0.001）、新生儿死亡率（p<0.001）和因伤害导致的死亡（p<0.001）相关。GAPS 总分和子项得分的基准得分包括了大多数医院水平的机构。
GAPS 工具和评分，通过基于能力的加权系统得到增强，标志着在评估资源有限环境中的儿科外科能力方面取得了进展。通过反映低资源中心医院功能的复杂现实，它提供了一种更精细的机制，用于促进有效的伙伴关系和数据驱动的战略干预。
