A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care
A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care
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DOI：
10.1186/s13075-020-02151-w
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发表时间：
2020-03-19
影响因子：
4.9
通讯作者：
Marshall, Deborah A.
中科院分区：
文献类型：
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作者：
Barber, Claire E. H.;Twilt, Marinka;Marshall, Deborah A.
背景：评估幼年特发性关节炎(JIA)的护理质量对于提高患者预后至关重要，但目前并不是加拿大所有中心常规护理的一部分。这项研究的目标是回顾JIA质量措施的现状，并利用专家小组的共识来定义关键绩效指标(KPI)，这些KPI对于收集JIA在加拿大护理中的常规监测是重要的和可行的。方法由3名儿科风湿病专家组成的工作小组对从系统综述中确定的37个候选关键绩效指标进行综述。然后使用基于兰德/加州大学洛杉矶分校适宜性方法的3轮改良德尔菲小组对14项关键绩效指标的入围名单进行评估。加拿大各地的10名小组成员根据他们在JIA、质量测量或作为JIA儿童父母的生活经验方面的专业知识参加了这次活动。在第一轮和第三轮中，专家小组成员根据重要性、可行性和优先级等主题对每个KPI进行了1-9分的Likert评分。在第2轮中，小组成员参加了一次面对面的讨论，讨论结果是对一些关键绩效指标进行了微小的修改。在所有三个问题上得分中位数均为7分的KPI均纳入该框架。结果10项KPI在第3轮后符合纳入标准。5项KPI涉及患者评估：疼痛、关节计数、功能状态、疾病活动的全球评估和临床青少年关节炎疾病活动评分(CJADAS)。三个KPI检查了获得护理的机会：咨询的等待时间，在诊断后一年内获得儿科风湿科医生的机会，以及临床随访的频率。通过结核病筛查和实验室监测的关键绩效指标来解决安全性问题。由于担心测量的可行性，使用儿童健康评估问卷(CHAQ)检查功能状态、生活质量、葡萄膜炎和患者满意度的KPI被排除在外。结论：拟议的关键绩效指标建立在现有关键绩效指标的基础上，并解决了应衡量的重要护理流程，以提高JIA护理质量。获取这些措施的可行性将在包括了解儿童关节炎网络(UCAN)研究在内的各种数据来源中进行测试。后续工作应侧重于开发有意义的成果关键绩效指标，以推动加拿大及其他地区的JIA质量改进。
Background The evaluation of quality of care in juvenile idiopathic arthritis (JIA) is critical for advancing patient outcomes but is not currently part of routine care across all centers in Canada. The study objective is to review the current landscape of JIA quality measures and use expert panel consensus to define key performance indicators (KPIs) that are important and feasible to collect for routine monitoring in JIA care in Canada. Methods Thirty-seven candidate KPIs identified from a systematic review were reviewed for inclusion by a working group including 3 pediatric rheumatologists. A shortlist of 14 KPIs was then assessed using a 3-round modified Delphi panel based on the RAND/UCLA Appropriateness Method. Ten panelists across Canada participated based on their expertise in JIA, quality measurement, or lived experience as a parent of a child with JIA. During rounds 1 and 3, panelists rated each KPI on a 1-9 Likert scale on themes of importance, feasibility, and priority. In round 2, panelists participated in a moderated in-person discussion that resulted in minor modifications to some KPIs. KPIs with median scores of >= 7 on all 3 questions without disagreement were included in the framework. Results Ten KPIs met the criteria for inclusion after round 3. Five KPIs addressed patient assessments: pain, joint count, functional status, global assessment of disease activity, and the clinical Juvenile Arthritis Disease Activity Score (cJADAS). Three KPIs examined access to care: wait times for consultation, access to pediatric rheumatologists within 1 year of diagnosis, and frequency of clinical follow-up. Safety was addressed through KPIs on tuberculous screening and laboratory monitoring. KPIs examining functional status using the Childhood Health Assessment Questionnaire (CHAQ), quality of life, uveitis, and patient satisfaction were excluded due to concerns about feasibility of measurement. Conclusions The proposed KPIs build upon existing KPIs and address important processes of care that should be measured to improve the quality of JIA care. The feasibility of capturing these measures will be tested in various data sources including the Understanding Childhood Arthritis Network (UCAN) studies. Subsequent work should focus on development of meaningful outcome KPIs to drive JIA quality improvement in Canada and beyond.