Abstract
BackgroundAs global emergency care grows, practical and effective performance measures are needed to ensure high quality care. Our objective was to systematically catalog and classify metrics that have been used to measure the quality of emergency care in resource-limited settings.MethodsWe searched MEDLINE, Embase, CINAHL, and the gray literature using standardized terms. The references of included articles were also reviewed. Two researchers screened titles and abstracts for relevance; full text was then reviewed by three researchers. A structured data extraction tool was used to identify and classify metrics into one of six Institute of Medicine (IOM) quality domains (safe, timely, efficient, effective, equitable, patient-centered) and one of three of Donabedian’s structure/process/outcome categories. A fourth expert reviewer blinded to the initial classifications re-classified all indicators, with a weighted kappa of 0.89.ResultsA total of 1705 articles were screened, 95 received full text review, and 34 met inclusion criteria. One hundred eighty unique metrics were identified, predominantly process (57 %) and structure measures (27 %); 16 % of metrics were related to outcomes. Most metrics evaluated the effectiveness (52 %) and timeliness (28 %) of care, with few addressing the patient centeredness (11 %), safety (4 %), resource-efficiency (3 %), or equitability (1 %) of care.ConclusionsThe published quality metrics in emergency care in resource-limited settings primarily focus on the effectiveness and timeliness of care. As global emergency care is built and strengthened, outcome-based measures and those focused on the safety, efficiency, and equitability of care need to be developed and studied to improve quality of care and resource utilization.Electronic supplementary materialThe online version of this article (doi:10.1186/s12245-015-0088-x) contains supplementary material, which is available to authorized users.
Highlights
As global emergency care grows, practical and effective performance measures are needed to ensure high quality care
Our study shows that when applying a structured framework for quality metrics to the over 150 metrics currently used to measure the quality of emergency care in low- and middle-income countries (LMICs), these metrics do not achieve balance
Literature in high-income countries suggests that the most successful performance measures for quality improvement are outcome metrics related to emergency departments (EDs) time intervals and patient centeredness (72-h ED returns, patients who left without being seen) [8, 50, 51], we found that only 16 % of metrics in LMICS were outcome based
Summary
As global emergency care grows, practical and effective performance measures are needed to ensure high quality care. The increasing burden of trauma and non-communicable diseases in low- and middle-income countries (LMICs) has emphasized the need for effective emergency care to alleviate the morbidity and mortality associated with acute illness and injury [1,2,3,4]. This has led international organizations, including the World Bank, World Health Organization, and United Nations Children’s Fund, to. While systematic performance measurement is the foundation of quality health care [10], quality and safety indicators used in developed countries may not be appropriate in resource-limited settings [9, 11].
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