Abstract
BackgroundIndicators of quality of care for children in hospitals in low-income countries have been proposed, but information on their perceived validity and acceptability is lacking.MethodsPotential indicators representing structural and process aspects of care for six common conditions were selected from existing, largely qualitative WHO assessment tools and guidelines. We employed the Delphi technique, which combines expert opinion and existing scientific information, to assess their perceived validity and acceptability. Panels of experts, one representing an international panel and one a national (Kenyan) panel, were asked to rate the indicators over 3 rounds and 2 rounds respectively according to a variety of attributes.ResultsBased on a pre-specified consensus criteria most of the indicators presented to the experts were accepted: 112/137(82%) and 94/133(71%) for the international and local panels respectively. For the other indicators there was no consensus; none were rejected. Most indicators were rated highly on link to outcomes, reliability, relevance, actionability and priority but rated more poorly on feasibility of data collection under routine conditions. There was moderate to substantial agreement between the two panels of experts.ConclusionsThis Delphi study provided evidence for the perceived usefulness of most of a set of measures of quality of hospital care for children proposed for use in low-income countries. However, both international and local experts expressed concerns that data for many process-based indicators may not currently be available. The feasibility of widespread quality assessment and responsiveness of indicators to intervention should be examined as part of continued efforts to improve approaches to informative hospital quality assessment.
Highlights
Indicators of quality of care for children in hospitals in low-income countries have been proposed, but information on their perceived validity and acceptability is lacking
The WHO revised an earlier tool for assessing the quality of care in first-referral health care facilities in developing countries, based on multi-country experience and informed by discussions at a global WHO meeting in Bali in 2007 [14]
Responses Forty percent of those invited to the international panel declined the offer, citing reasons including lack of time and insufficient experience of the topic. 10% and 24 % of the international experts returning round 1 did not complete rounds 2 and 3 respectively. 16/19 of the local experts invited to participate in the process accepted the offer and all but one completed the process
Summary
Indicators of quality of care for children in hospitals in low-income countries have been proposed, but information on their perceived validity and acceptability is lacking. Delivery of good quality health care has considerable potential to reduce childhood deaths in low-income countries where mortality is high [1,2]. Both anecdotal and empirical evidence suggest that the quality of care offered in many facilities, both primary and referral, is generally poor [3,4,5,6,7,8]. Uptake of the tool will probably depend on “buy in” and support from influential persons in each country Using this tool, structure and processes of care are rated on a simple semi-qualitative scale (the latter based on a convenience sample of 5 cases) making it useful for rapid appraisal of hospitals. Such scores are of limited value if the aim is to provide an objective comparison between hospitals within a region or within hospitals at different periods - if different observers use the tool
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