Top

Published in:

01-06-2018 | Original Article

Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU

Authors: Dominik A. Ewald, Gottfried Huss, Silke Auras, Juan Ruiz-Canela Caceres, Adamos Hadjipanayis, Max Geraedts

Published in: European Journal of Pediatrics | Issue 6/2018

Abstract

Paediatric ambulatory healthcare systems in Europe are, because of historical reasons, diverse and show strikingly different outcomes. All across Europe, the benchmarking of structures, processes and outcomes could reveal opportunities for improving Paediatric Primary Care (PPC). The aim of this study was to develop a set of Quality Indicators (QIs) to assess and monitor PPC in Europe. In a three-step process, we used the available external evidence and European expert consensus in a modified RAND/UCLA Appropriateness Method (RAM) to develop an indicator set. (1) A broad literature and online research of published QI and guidelines yielded an inventory of 1516 QI. (2) A collaborative panel of paediatric senior experts from the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) from 15 European countries participated in a first consensus process to reduce the initial indicator inventory by eliminating not PPC-focused indicators and duplicates. (3) In a second consensus process, the panel rated the QI regarding validity and feasibility. The final QI set “COSI-PPC-EU” consists of 42 indicators in five categories of PPC: (A) health promotion/prevention/screening (13 QI), (B) acute care (9 QI), (C) chronic care (8 QI), (D) practice management (3 QI) and (E) patient safety (9 QI).

Conclusion: COSI-PPC-EU represents a consented set of a limited number of valid quality indicators for the application in paediatric primary care in different healthcare systems throughout Europe.

What is Known:

• Paediatric ambulatory healthcare systems in Europe are diverse and show strikingly different outcomes.

• There are known gaps in quality performance measures of paediatric primary care in Europe. Pre-existing sets of quality indicators are predominantly limited to national populations, specific diseases and hospital care.

What is New:

• A set of 42 quality indicators for primary paediatric care in Europe was developed in a multi-country collaborative effort. The method combined a systematic literature review and a consensus process among European paediatric experts.

• The quality indicator set can facilitate quality improvement of PPC. After studying the feasibility, providers can use COSI-PPC-EU to monitor, compare and improve performance of practices, regions and countries.

Altenhofen L, Brech W, Brenner G, Geraedts G, Gramsch E, Kolkmann FW, Rheinberger P (2001) Beurteilung klinischer Messgrößen des Qualitätsmanagements. Zentralstelle der Deutschen Ärzteschaft zur Qualitätssicherung in der Medizin. Gemeinsame Einrichtung der Bundesärztekammer und der Kassenärztlichen Bundesvereinigung. ÄZQ.

Arah OA, Westert GP, Hurst J, Klazinga NS (2006) A conceptual framework for the OECD Health Care Quality Indicators Project. Int J Qual Health Care 18:5–13. https://doi.org/10.1093/intqhc/mzl024 CrossRefPubMed

Bach S (2003) International migration of health workers: labour and social issues. Geneva Int. Labour Office. https://www.aspeninstitute.org/content/uploads/files/content/images/Bach%20Health%20worker%20Migration%20WP.pdf. Accessed 01 Aug 2017

Brook RH (1995) The RAND/UCLA appropriateness method. https://www.rand.org/pubs/reprints/RP395.html. Accessed 18 Sep 2016

Buchan J (2008) Wie kann die Migration von Gesundheitsfachkräften gesteuert werden, um negative Auswirkungen auf das Angebot zu verhindern? WHO, Regional Office for Europe. http://www.euro.who.int/__data/assets/pdf_file/0008/76427/E93414G.pdf. Accessed 01 Aug 2017

Caplin DA, Rao JK, Filloux F, Bale JF, van Orman C (2006) Development of performance indicators for the primary care management of pediatric epilepsy: expert consensus recommendations based on the available evidence: quality indicators for paediatric epilepsy. Epilepsia 47:2011–2019. https://doi.org/10.1111/j.1528-1167.2006.00853.x CrossRefPubMed

Cheung CRLH, Gray JAM (2013) Unwarranted variation in health care for children and young people. Arch Dis Child 98:60–65. https://doi.org/10.1136/archdischild-2012-302041 CrossRefPubMed

de Cruppé W, Kleudgen S, Diel F, Burgdorf F, Geraedts M (2015) Feasibility of 48 quality indicators in ambulatory care in Germany: a cross-sectional observational study. Z Evid Fortbild Qual Im Gesundhwes 109:682–694. https://doi.org/10.1016/j.zefq.2015.02.015 CrossRef

Del Torso S, Pettoello-Mantovani M, Tenore A et al (2013) A strategic pediatric alliance for the future health of children in Europe. J Pediatr 162:659–660. https://doi.org/10.1016/j.jpeds.2012.11.043 CrossRefPubMed

10.

Donabedian A (1966) Evaluating the quality of medical care. Milbank Mem Fund Q 44:166–206. https://doi.org/10.2307/3348969 CrossRef

11.

Donaldson MS, et al (1999) Measuring the quality of health care. The National Roundtable on Health Care Quality, Institute of Medicine. National Academies Press, free downloaded from: http://www.nap.edu/catalog/6418.html. Accessed 23 Febr 2017

12.

Dougherty D, Schiff J, Mangione-Smith R (2011) The children’s health insurance program reauthorization act quality measures initiatives: moving forward to improve measurement, care, and child and adolescent outcomes. Acad Pediatr 11:S1–S10. https://doi.org/10.1016/j.acap.2011.02.009 CrossRefPubMed

13.

van den Driessen Mareeuw FA, Hollegien MI, Coppus AMW, Delnoij DMJ, de Vries E (2017) In search of quality indicators for Down syndrome healthcare: a scoping review. BMC Health Serv Res 17:284. https://doi.org/10.1186/s12913-017-2228-x CrossRefPubMedPubMedCentral

14.

Engels Y, Campbell S, Dautzenberg M, van den Hombergh P, Brinkmann H, Szécsényi J, Falcoff H, Seuntjens L, Kuenzi B, Grol R, EPA Working Party (2005) Developing a framework of, and quality indicators for, general practice management in Europe. Fam Pract 22:215–222. https://doi.org/10.1093/fampra/cmi002 CrossRefPubMed

15.

Engels Y, Dautzenberg M, Campbell S, Broge B, Boffin N, Marshall M, Elwyn G, Vodopivec-Jamsek V, Gerlach FM, Samuelson M, Grol R (2006) Testing a European set of indicators for the evaluation of the management of primary care practices. Fam Pract 23:137–147. https://doi.org/10.1093/fampra/cmi091 CrossRefPubMed

16.

van Esso D, del Torso S, Hadjipanayis A, Biver A, Jaeger-Roman E, Wettergren B, Nicholson A, and the members of the Primary-Secondary Working Group (PSWG) of the European Academy of Paediatrics (EAP) (2010) Paediatric primary care in Europe: variation between countries. Arch Dis Child 95:791–795. https://doi.org/10.1136/adc.2009.178459 CrossRefPubMed

17.

Faro EZ, Wang CJ, Oyeku SO (2016) Quality Indicator development for positive screen follow-up for sickle cell disease and trait. Am J Prev Med 51:S48–S54. https://doi.org/10.1016/j.amepre.2016.01.005 CrossRefPubMed

18.

Fitch K, Bernstein SJ, Aguilar MD et al (2001) The RAND/UCLA appropriateness method user’s manual. RAND Cooperation, Santa Monica

19.

Gill PJ, O’Neill B, Rose P et al (2014) Primary care quality indicators for children: measuring quality in UK general practice. Br J Gen Pract 64:e752–e757. https://doi.org/10.3399/bjgp14X682813 CrossRefPubMedPubMedCentral

20.

Hartveit M, Vanhaecht K, Thorsen O, Biringer E, Haug K, Aslaksen A (2017) Quality indicators for the referral process from primary to specialised mental health care: an explorative study in accordance with the RAND appropriateness method. BMC Health Serv Res 17:4. https://doi.org/10.1186/s12913-016-1941-1 CrossRefPubMedPubMedCentral

21.

Hasenfuß G, Märker-Hermann E, Hallek M, Sieber C (2016) Klug entscheiden: Allem voran die Indikationsqualität. Internist 57:519–520. https://doi.org/10.1007/s00108-016-0077-z CrossRefPubMed

22.

Hermann RC, Mattke S, Somekh D, Silfverhielm H, Goldner E, Glover G, Pirkis J, Mainz J, Chan JA (2006) Quality indicators for international benchmarking of mental health care. Int J Qual Health Care 18:31–38. https://doi.org/10.1093/intqhc/mzl025 CrossRefPubMed

23.

Katz M, Rubino A, Collier J, Rosen J, Ehrich JHH (2002) Demography of pediatric primary care in Europe: delivery of care and training. Pediatrics 109:788–796CrossRefPubMed

24.

Kelley E (2006) Beyond the initial indicators: lessons from the OECD Health Care Quality Indicators Project and the US National Healthcare Quality Report. Int J Qual Health Care 18:45–51. https://doi.org/10.1093/intqhc/mzl027 CrossRefPubMed

25.

Kohn L, Corrigan J, Donaldson M (2000) To err is human: building a safer health system. National Academies Press, Washington, D.C. https://doi.org/10.17226/9728

26.

Kraft E, Hersperger M, Herren D (2012) Diagnose und Indikation als Schlüsseldimensionen der Qualität. Schweiz Ärzteztg 93:1485–1489. http://r4.fmh.ch/files/pdf8/GLP_Diagnose_und_Indikation_als_Schlsseldimension_der_Qualitt_SAEZ_Nr._41_20122.pdf. Accessed 02 Aug 2017

27.

Mangione-Smith R, DeCristofaro AH, Setodji CM et al (2007) The quality of ambulatory care delivered to children in the United States. N Engl J Med 357:1515–1523CrossRefPubMed

28.

Mangione-Smith R, Schiff J, Dougherty D (2011) Identifying children’s health care quality measures for Medicaid and CHIP: an evidence-informed, publicly transparent expert process. Acad Pediatr 11:S11–S21CrossRefPubMed

29.

Marshall M (2006) OECD Health Care Quality Indicator Project. The expert panel on primary care prevention and health promotion. Int J Qual Health Care 18:21–25. https://doi.org/10.1093/intqhc/mzl021 CrossRefPubMed

30.

Mattke S, Epstein AM, Leatherman S (2006) The OECD Health Care Quality Indicators Project: history and background. Int J Qual Health Care 18:1–4. https://doi.org/10.1093/intqhc/mzl019 CrossRefPubMed

31.

Mattke S, Nicolucci A, Greenfield S (2004) Selecting indicators for the quality of diabetes care at the health systems level in OECD countries. Int J Qual Health Care 18:26–30. https://doi.org/10.1787/165531523300

32.

Mattke S, Scherer P, Expert Group Members H et al (2006) Health care quality indicators project. OECD Health Working Papers 22. https://doi.org/10.1787/481685177056

33.

McGlynn EA, Kerr EA, Damberg CL, Asch SM (2000) Quality of care for women. http://www.rand.org/pubs/monograph_reports/MR1284.html. Accessed 18 Sep 2016

34.

Mercieca C, Aquilina K, Pullicino R, Borg AA (2012) Freedom of movement across the EU: legal and ethical issues for children with chronic disease. J Med Ethics 38:694–696. https://doi.org/10.1136/medethics-2012-041475 CrossRefPubMed

35.

Nicolucci A, Greenfield S, Mattke S (2006) Selecting indicators for the quality of diabetes care at the health systems level in OECD countries. Int J Qual Health Care 18:26–30. https://doi.org/10.1093/intqhc/mzl023 CrossRefPubMed

36.

Rigby MJ, Köhler LI, Blair ME, Metchler R (2003) Child health indicators for Europe: a priority for a caring society. Eur J Pub Health 13:38–46CrossRef

37.

Rotar AM, van den Berg MJ, Kringos DS, Klazinga NS (2016) Reporting and use of the OECD health care quality indicators at national and regional level in 15 countries. Int J Qual Health Care J Int Soc Qual Health Care 28:398–404. https://doi.org/10.1093/intqhc/mzw027

38.

Ruiz-Canela-Cáceres J, Aquino-Llinares N, Sánchez-Diaz JM, García-Gestoso ML, de Jaime-Revuelta ME, Praena-Crespo M (2015) Indicators for childhood asthma in Spain, using the Rand method. Allergol Immunopathol (Madr) 43:147–156. https://doi.org/10.1016/j.aller.2013.12.005 CrossRef

39.

Salzer-Muhar U, Pollak A, Aufricht C, Ehrich J, Lenton S (2012) European challenges: cross-border care for children. J Pediatr 161:574–576. https://doi.org/10.1016/j.jpeds.2012.06.052 CrossRefPubMed

40.

Skrundz M, Borusiak P, Hameister KA, Geraedts M (2015) Entwicklung und Implementierung von Qualitätsindikatoren in der Sozialpädiatrie für das Krankheitsbild ADHS [The development of quality indicators for management of patients with ADHD in social paediatrics]. Gesundheitswes Bundesverb Ärzte Öffentl Gesundheitsdienstes Ger 77:908–915. https://doi.org/10.1055/s-0034-1389922 CrossRef

41.

Terracciano L, Brozek J, Compalati E, Schünemann H (2010) GRADE system: new paradigm. Curr Opin Allergy Clin Immunol 10:377–383. https://doi.org/10.1097/ACI.0b013e32833c148b CrossRefPubMed

42.

To T, Guttmann A, Lougheed MD et al (2010) Evidence-based performance indicators of primary care for asthma: a modified RAND appropriateness method. Int J Qual Health Care 22:476–485. https://doi.org/10.1093/intqhc/mzq061 CrossRefPubMed

43.

UNICEF MICS. Monitoring the situation of children and women for 20 years. http://54.92.12.252/files?job=W1siZiIsIjIwMTUvMDkvMTQvMTcvNTUvMzcvNTI2LzIwMTUwOTEyX01JQ1MyMF9XRUIucGRmIl1d&sha=da0e0b8ac785c628. Accessed 23 Feb 2017

44.

UNICEF MICS. Definitions of indicators. http://mics.unicef.org/files?job=W1siZiIsIjIwMTUvMDQvMDMvMDYvNDIvNDcvOTYvYXBwZW5kNC5wZGYiXV0&sha=f8f48d64e09eb591. Accessed 23 Feb 2017

45.

van Velthoven MH, Mastellos N, Majeed A, O’Donoghue J, Car J (2016) Feasibility of extracting data from electronic medical records for research: an international comparative study. BMC Med Inform Decis Mak 16:90. https://doi.org/10.1186/s12911-016-0332-1 CrossRefPubMedPubMedCentral

46.

Weir SS (2005) Disease management in primary care: rapid cycle quality improvement of asthma care. NC Med J 66:219–220

47.

Wolfe I, Thompson M, Gill P, Tamburlini G, Blair M, van den Bruel A, Ehrich J, Pettoello-Mantovani M, Janson S, Karanikolos M, McKee M (2013) Health services for children in western Europe. Lancet 381:1224–1234. https://doi.org/10.1016/S0140-6736(12)62085-6 CrossRefPubMed

48.

Wong ICK, Ghaleb MA, Franklin BD, Barber N (2004) Incidence and nature of dosing errors in paediatric medications. Drug Saf 27:661–670. https://doi.org/10.2165/00002018-200427090-00004 CrossRefPubMed

49.

Wroth T, Bols J (2005) Application of quality-improvement methods in a community practice: the Sandhills pediatrics asthma initiative. NC Med J 66:218–220

50.

DIRECTIVE 2011/24/EU OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 9 March 2011 on the application of patients’ rights in cross-border healthcare (2011). http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:088:0045:0065:EN:PDF. Accessed 23 Jan 2017

51.

Recht auf Behandlung. http://europa.eu/youreurope/citizens/health/planned-healthcare/right-to-treatment/index_de.htm. Accessed 27 Aug 2017

52.

REGULATION (EU) No 282/2014 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 11 March 2014 on the establishment of a third Programme for the Union's action in the field of health (2014-2020) and repealing Decision No 1350/2007/EC. EUR-Lex-32014R0282-EN-EUR-Lex. http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv%3AOJ.L_.2014.086.01.0001.01.ENG. Accessed 27 Aug 2017

53.

Welcome Note - Pediatrician. Eur Acad Paediatr Paediatr Sect. UEMS http://eapaediatrics.eu/welcome-note/. Accessed 08 Nov 2016

54.

WHO - Children’s environmental health indicators. http://www.who.int/ceh/publications/cehi_brochure/en/. Accessed 18 Sep 2016

Title: Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU
Authors: Dominik A. Ewald
Gottfried Huss
Silke Auras
Juan Ruiz-Canela Caceres
Adamos Hadjipanayis
Max Geraedts
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 6/2018
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-018-3140-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Development of a core set of quality indicators for paediatric primary care practices in Europe, COSI-PPC-EU

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2018

Eyelash length for the diagnosis of atopic dermatitis and ichthyosis vulgaris in children—a case control study

Prevalence of overweight/obesity among 7-year-old children—WHO Childhood Obesity Surveillance Initiative in Slovakia, trends and differences between selected European countries

Diagnostic characteristics of anterior cutaneous nerve entrapment syndrome in childhood

Performance and skill retention of five supraglottic airway devices for the pediatric difficult airway in a manikin

Dutch guideline for clinical foetal-neonatal and paediatric post-mortem radiology, including a review of literature

Pain and quality of life of children and adolescents with osteogenesis imperfecta over a bisphosphonate treatment cycle