Global core indicators for measuring WHO's paediatric quality-of-care standards in health facilities: development and expert consensus

Abstract

Background: There are currently no global recommendations on a parsimonious and robust set of indicators that can be measured routinely or periodically to monitor quality of hospital care for children and young adolescents. We describe a systematic methodology used to prioritize and define a core set of such indicators and their metadata for progress tracking, accountability, learning and improvement, at facility, (sub) national, national, and global levels.

Methods: We used a deductive methodology which involved the use of the World Health Organization Standards for improving the quality-of-care for children and young adolescents in health facilities as the organizing framework for indicator development. The entire process involved 9 complementary steps which included: a rapid literature review of available evidence, the application of a peer-reviewed systematic algorithm for indicator systematization and prioritization, and multiple iterative expert consultations to establish consensus on the proposed indicators and their metadata.

Results: We derived a robust set of 25 core indicators and their metadata, representing all 8 World Health Organization quality standards, 40 quality statements and 520 quality measures. Most of these indicators are process-related (64%) and 20% are outcome/impact indicators. A large proportion (84%) of indicators were proposed for measurement at both outpatient and inpatient levels. By virtue of being a parsimonious set and given the stringent criteria for prioritizing indicators with "quality measurement" attributes, the recommended set is not evenly distributed across the 8 quality standards.

Conclusions: To support ongoing global and national initiatives around paediatric quality-of-care programming at country level, the recommended indicators can be adopted using a tiered approach that considers indicator measurability in the short-, medium-, and long-terms, within the context of the country's health information system readiness and maturity. However, there is a need for further research to assess the feasibility of implementing these indicators across contexts, and the need for their validation for global common reporting.

Keywords: Child health; Consultation; Global; Indicators; Measurement; Methodology; Quality-of-care; Robust; WHO quality-of-care standards; Young adolescent.

Fig. 1

Structure of the WHO QSs for improving the quality of paediatric and young adolescent care in health facilities

Fig. 2

A stepwise process used to develop the core indicators

Fig. 3

Flow diagram of core indicator prioritization and development process (*System categories: each QM was systematized by the QoC element it measured: input, process (adherence to EB practices, non-evidence-based, harmful practices), or a related outcome/impact. Input measures were further systematized by various input categories: a) Medicines, supplies and equipment, infrastructure; b) Clinical guidelines, protocols, job aides; c) Operational guidelines, protocols; d) trained human resources; e) availability of health services f) financing g) health information system; h) organization of care processes; i) oversight and management. **Importance: This criterion was used to prioritize all measurement subdomains, but, as shown in Table 1, it was framed differently under each measurement domain or subdomain. ^#Clinical content area: List of prioritized clinical content areas used to select QMs is provided in the Additional File 3)