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Gyawali R, Toomey M, Stapleton F, Ho KC, Keay L, Pye DC, Katalinic P, Liew G, Hsing YI, Ramke J, Gentle A, Webber AL, Schmid KL, Bentley S, Hibbert P, Wiles L, Jalbert I. Clinical indicators for diabetic eyecare delivered by optometrists in Australia: a Delphi study. Clin Exp Optom 2024; 107:571-580. [PMID: 37848180 DOI: 10.1080/08164622.2023.2253792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/28/2023] [Indexed: 10/19/2023] Open
Abstract
CLINICAL RELEVANCE Valid and updated clinical indicators can serve as important tools in assessing and improving eyecare delivery. BACKGROUND Indicators for diabetic eyecare in Australia were previously developed from guidelines published before 2013 and then used to assess the appropriateness of care delivery through a nationwide patient record card audit (the iCareTrack study). To reflect emerging evidence and contemporary practice, this study aimed to update clinical indicators for optometric care for people with type 2 diabetes in Australia. METHODS Forty-five candidate indicators, including existing iCareTrack and new indicators derived from nine high-quality evidence-based guidelines, were generated. A two-round modified Delphi process where expert panel members rated the impact, acceptability, and feasibility of the indicators on a 9-point scale and voted for inclusion or exclusion of the candidate indicators was used. Consensus on inclusion was reached when the median scores for impact, acceptability, and feasibility were ≥7 and >75% of experts voted for inclusion. RESULTS Thirty-two clinical indicators with high acceptability, impact and feasibility ratings (all median scores: 9) were developed. The final indicators were related to history taking (n = 12), physical examination (n = 8), recall period (n = 5), referral (n = 5), and patient education/communication (n = 2). Most (14 of 15) iCareTrack indicators were retained either in the original format or with modifications. New indicators included documenting the type of diabetes, serum lipid level, pregnancy, systemic medications, nephropathy, Indigenous status, general practitioner details, pupil examination, intraocular pressure, optical coherence tomography, diabetic retinopathy grading, recall period for high-risk diabetic patients without retinopathy, referral of high-risk proliferative retinopathy, communication with the general practitioner, and patient education. CONCLUSION A set of 32 updated diabetic eyecare clinical indicators was developed based on contemporary evidence and expert consensus. These updated indicators inform the development of programs to assess and enhance the eyecare delivery for people with diabetes in Australia.
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Affiliation(s)
- Rajendra Gyawali
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Melinda Toomey
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - David C Pye
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Paula Katalinic
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Yan Inez Hsing
- Department of Optometry, Okko Eye Specialist Centre, Upper Mount Gravatt, Queensland, Australia
| | - Jacqueline Ramke
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Alex Gentle
- School of Medicine, Deakin University, Geelong, Victoria Australia
| | - Ann L Webber
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katrina L Schmid
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sharon Bentley
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
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Alghamdi S, Dixon N, Al-Senani F, Al Aseri Z, Al Saif S, AlTahan T. Effects of a team Quality Improvement method in a national clinical audit programme of four clinical specialties in Ministry of Health hospitals in Saudi Arabia. Int J Qual Health Care 2024; 36:mzad107. [PMID: 38153764 PMCID: PMC10842466 DOI: 10.1093/intqhc/mzad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/29/2023] [Accepted: 12/24/2023] [Indexed: 12/29/2023] Open
Abstract
In 2018, the Ministry of Health (MoH) in Saudi Arabia developed a clinical excellence strategy. An objective was to reduce variation in clinical practices in MoH hospitals, particularly for conditions with high mortality in Saudi Arabia, by applying best practice clinical standards and using the clinical audit process to measure clinical practice. The strategy included working with multiprofessional teams in hospitals to implement improvements needed in clinical practice. To test the feasibility of carrying out national clinical audits in MoH hospitals, audits were carried out in 16 MoH hospitals on four clinical subjects-acute myocardial infarction, major trauma, sepsis, and stroke. Clinical expert groups, including Saudi clinicians and an international clinical expert, developed clinical care standards for the four conditions from analyses of international and Saudi clinical guidelines. The audits were designed with the expert groups. Multiprofessional teams were appointed to carry out the audits in designated MoH hospitals. Data collectors in each hospital were trained to collect data. Workshops were held with the teams on the clinical care standards and how data would be collected for the audits, and later, on the findings of data collection and how to use the improvement process to implement changes to improve compliance with the standards. After 4 months, data collection was repeated to determine if compliance with the clinical care standards had improved. Data collected from each hospital for both cycles of data collection were independently reliably tested. All designated hospitals participated in the audits, collecting and submitting data for two rounds of data collection and implementing improvement plans after the first round of data collection. All hospitals made substantial improvements in clinical practices. Of a total of 84 measures used to assess compliance with a total of 52 clinical care standards for the four clinical conditions, improvements were made by hospital teams in 58 (69.1%) measures. Improvements were statistically significant for 34 (40.5%) measures. The project demonstrated that well-designed and executed audits using evidence-based clinical care standards can result in substantial improvements in clinical practices in MoH hospitals in Saudi Arabia. Keys to success were the improvement methodology built into the audit process and the requirement for hospitals to appoint multiprofessional teams to carry out the audits. The approach adds to evidence on the effectiveness of clinical audits in achieving improvements in clinical quality and can be replicated in national audit programmes.
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Affiliation(s)
- Saleh Alghamdi
- Clinical Excellence General Directorate, Ministry of Health, Riyadh 14726, Saudi Arabia
| | - Nancy Dixon
- Healthcare Quality Quest, Shelley Farm, Shelley Lane, Ower, Romsey, Hampshire SO51 6AS, United Kingdom
| | - Fahmi Al-Senani
- Stroke Saudi Clinical Expert Group, Model of Care Programme, Ministry of Health, Riyadh 11525, Saudi Arabia
| | - Zohair Al Aseri
- Sepsis Saudi Clinical Expert Group, Departments of Emergency and Critical Care, College of Medicine, King Saud University and Department of Clinical Sciences, College of Medicine, Riyadh Hospital, Dar Al Uloom University, Adult ICU services, Ministry of Health, Riyadh 145111, Saudi Arabia
| | - Shukri Al Saif
- Myocardial Infarction Saudi Clinical Expert Group, Eastern Health Cluster, Saudi Al-Babtain Cardiac Centre, Qatif, Dammam 32632, Saudi Arabia
| | - Talal AlTahan
- Major Trauma Saudi Clinical Expert Group, Prince Mohammed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia
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What Constitutes "Appropriate Care" for Low Back Pain?: Point-of-Care Clinical Indicators From Guideline Evidence and Experts (the STANDING Collaboration Project). Spine (Phila Pa 1976) 2022; 47:879-891. [PMID: 34798647 DOI: 10.1097/brs.0000000000004274] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multiround wiki-based Delphi expert panel survey. OBJECTIVE To provide proof of concept for an alternative method for creating sets of nationally-agreed point-of-care clinical indicators, and obtain consensus among end-user groups on "appropriate care" for the assessment, diagnosis, acute, and ongoing care of people with low back pain (LBP). SUMMARY OF BACKGROUND DATA The provision of inappropri ate and low value care for LBP is a significant healthcare and societal burden. Vague clinical practice guideline (CPG) recom mendations can be difficult to apply and measure in real world clinical practice, and a likely barrier to "appropriate care." METHODS Draft "appropriate care" clinical indicators for LBP were derived from CPG recommendations published between 2011 and 2017. Included CPGs were independently appraised by two reviewers using the Appraisal of Guidelines for Research and Evaluation instrument. Headed by a Clinical Champion, a 20-member Expert Panel reviewed and commented on the draft indicators over a three-round modified e-Delphi process using a collaborative online wiki. At the conclusion of each review round, the research team and the Clinical Champion synthesized and responded to experts' comments and incorporated feedback into the next iteration of the draft indicators. RESULTS From seven CPGs and six qualitative meta-syntheses, 299 recommendations and themes were used to draft 42 "appropriateness" indicators. In total, 17 experts reviewed these indicators over 18 months. A final set of 27 indicators compris ing screening and diagnostic processes (n = 8), assessment (n = 3), acute (n = 5), and ongoing care (n = 9), and two which crossed the acute-ongoing care continuum. Most indicators were geared toward recommended care (n = 21, 78%), with the remainder focused on care to be avoided. CONCLUSION These 27 LBP clinical indicators can be used by healthcare consumers, clinicians, researchers, policy makers/ funders, and insurers to guide and monitor the provision of "appropriate care" for LBP.Level of Evidence: 4.
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Hibbert PD, Molloy CJ, Wiles LK, Cameron ID, Gray LC, Reed RL, Kitson A, Georgiou A, Gordon SJ, Westbrook J, Arnolda G, Mitchell RJ, Rapport F, Estabrooks C, Alexander GL, Vincent C, Edwards A, Carson-Stevens A, Wagner C, McCormack B, Braithwaite J. Designing Clinical Indicators for Common Residential Aged Care Conditions and Processes of Care: The CareTrack Aged Development and Validation Study. Int J Qual Health Care 2022; 34:6571667. [PMID: 35445264 DOI: 10.1093/intqhc/mzac033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/27/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People who live in aged care homes have high rates of illness and frailty. Providing evidence-based care to this population is vital to ensure the highest possible quality of life. This study (CareTrack Aged, CT Aged) aimed to develop a comprehensive set of clinical indicators for guideline-adherent, appropriate care of commonly managed conditions and processes of care in aged care. METHODS Indicators were formulated from recommendations found through systematic searches of Australian and international clinical practice guidelines (CPGs). Experts reviewed the indicators using a multi-round modified Delphi process to develop consensus on what constitutes appropriate care. RESULTS From 139 CPGs, 5,609 recommendations were used to draft 630 indicators. Clinical experts (n=41) reviewed the indicators over two rounds. A final set of 236 indicators resulted, mapped to 16 conditions and processes of care. The conditions and processes were admission assessment; bladder and bowel problems; cognitive impairment; depression; dysphagia and aspiration; end of life/palliative care; hearing and vision; infection; medication; mobility and falls; nutrition and hydration; oral and dental care; pain; restraint use; skin integrity; and sleep. CONCLUSIONS The suite of CT Aged clinical indicators can be used for research, assessment of quality of care in individual facilities and across organisations to guide improvement, and to supplement regulation or accreditation of the aged care sector. They are a step forward for Australian and international aged care sectors, helping to improve transparency, so that the level of care delivered to aged care consumers can be rigorously monitored and continuously improved.
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Affiliation(s)
- Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.,South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, St Leonards, New South Wales, Australia
| | - Leonard C Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Richard L Reed
- Discipline of General Practice, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Susan J Gordon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca J Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Charles Vincent
- Department of Experimental Psychology, Radcliffe Observatory, University of Oxford, Oxford, England, United Kingdom
| | - Adrian Edwards
- PRIME Centre Wales & Division of Population Medicine, Cardiff University, Heath Park, Cardiff, Wales, United Kingdom
| | - Andrew Carson-Stevens
- PRIME Centre Wales & Division of Population Medicine, Cardiff University, Heath Park, Cardiff, Wales, United Kingdom
| | - Cordula Wagner
- Netherlands Institute for Health Services Research, Amsterdam University Medical Center, Utrecht/Amsterdam, The Netherlands
| | - Brendan McCormack
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland, United Kingdom
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Tischlik V, Mehl C, Ewald D, Heinzel-Gutenbrunner M, Geraedts M, Bachmann CJ. Assessment of the quality of routine ambulatory healthcare for common disorders in children and adolescents in Germany: study protocol for a retrospective medical record review (QualiPäd). BMJ Open 2021; 11:e048782. [PMID: 34815275 PMCID: PMC8611448 DOI: 10.1136/bmjopen-2021-048782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The quality of healthcare in childhood and adolescence is of key importance, in order to foster a healthy development and to avoid chronic health problems. Yet, data for Germany regarding the quality of healthcare for this patient group are lacking. The QualiPäd research project aims to estimate the quality of outpatient healthcare for children and adolescents in Germany, focusing on common psychiatric and physical disorders. METHODS AND ANALYSIS Quality indicators for seven common physical and mental childhood and adolescent clinical conditions (attention deficit/hyperactivity disorder, asthma, atopic dermatitis, depression, otitis media, conduct disorder/oppositional defiant disorder, tonsillitis) will be developed and ratified by experts, using the RAND/UCLA Appropriateness Method.Initially, 1400 medical records of children and adolescents with one of the aforementioned clinical conditions will then be randomly drawn from 40 outpatient practices in the German federal state of Hessen. The records will then be assessed regarding their adherence to the respective quality indicators. Based on this, the percentage of appropriate and inappropriate (eg, wasteful) healthcare of all clinical conditions (primary endpoint) will be estimated. Additionally, possible factors influencing the quality of care (eg, patient characteristics, type of condition, type of practice) will be identified using generalised estimation equation models. ETHICS AND DISSEMINATION This study will show for which of the studied clinical conditions and/or patients improvement of quality of care is necessary within the German health system. Also, the quality indicators designed for the study can afterwards be implemented in regular care and thus enable regular reporting of the outpatient care of this target group. The authors plan to disseminate their findings through international, peer-reviewed scientific publications, and through presentations at national and international paediatric and child psychiatric conferences. TRIAL REGISTRATION NUMBER DRKS00022408.
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Affiliation(s)
- Viktor Tischlik
- Department of Child and Adolescent Psychiatry, Universitätsklinikum Ulm, Ulm, Germany
| | - Claudia Mehl
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Max Geraedts
- Institute for Health Services Research and Clinical Epidemiology, Philipps-Universität Marburg, Marburg, Germany
| | - Christian J Bachmann
- Department of Child and Adolescent Psychiatry, Universitätsklinikum Ulm, Ulm, Germany
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Cohen CL, Walker KH, Hsiang M, Sonenthal PD, Riviello ED, Rouhani SA, Lipnick MS, Merriam LT, Kim EY. Combating information chaos: a case for collaborative clinical guidelines in a pandemic. CELL REPORTS MEDICINE 2021; 2:100375. [PMID: 34337553 PMCID: PMC8313756 DOI: 10.1016/j.xcrm.2021.100375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The speed and scale of new information during the COVID-19 pandemic required a new approach toward developing best practices and evidence-based clinical guidance. To address this need, we produced COVIDProtocols.org, a collaborative, evidence-based, digital platform for the development and dissemination of COVID-19 clinical guidelines that has been used by over 500,000 people from 196 countries. We use a Collaborative Writing Application (CWA) to facilitate an expedited expert review process and a web platform that deploys content directly from the CWA to minimize any delays. Over 200 contributors have volunteered to create open creative-commons content that spans over 30 specialties and medical disciplines. Multiple local and national governments, hospitals, and clinics have used the site as a key resource for their own clinical guideline development. COVIDprotocols.org represents a model for efficiently launching open-access clinical guidelines during crisis situations to share expertise and combat misinformation.
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Affiliation(s)
- C Lee Cohen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Katherine H Walker
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.,Harvard Medical School, Boston, MA 02115, USA
| | - Mina Hsiang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Paul D Sonenthal
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.,Harvard Medical School, Boston, MA 02115, USA.,Partners In Health, Boston, MA 02115, USA
| | - Elisabeth D Riviello
- Harvard Medical School, Boston, MA 02115, USA.,Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Shada A Rouhani
- Harvard Medical School, Boston, MA 02115, USA.,Partners In Health, Boston, MA 02115, USA.,Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Michael S Lipnick
- Center for Health Equity in Surgery and Anesthesia, University of California, San Francisco, CA 94110, USA
| | - Louis T Merriam
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Edy Y Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.,Harvard Medical School, Boston, MA 02115, USA
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Segelov E, Carrington C, Aranda S, Currow D, Zalcberg JR, Heriot AG, Mileshkin L, Coutsouvelis J, Millar JL, Collopy BT, Emery JD, Zhang P, Cooper S, O'Kane C, Wale J, Hancock SJ, Sulkowski A, Bashford J. Developing clinical indicators for oncology: the inaugural cancer care indicator set for the Australian Council on Healthcare Standards. Med J Aust 2021; 214:528-531. [PMID: 34053081 DOI: 10.5694/mja2.51087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The Australian Council on Healthcare Standards (ACHS) sponsored an expert-led, consensus-driven, four-stage process, based on a modified Delphi methodology, to determine a set of clinical indicators as quality measures of cancer service provision in Australia. This was done in response to requests from institutional health care providers seeking accreditation, which were additional and complementary to the existing radiation oncology set. The steering group members comprised multidisciplinary key opinion leaders and a consumer representative. Five additional participants constituted the stakeholder group, who deliberated on the final indicator set. METHODS AND RECOMMENDATIONS An initial meeting of the steering group scoped the high level nature of the desired set. In stage 2, 65 candidate indicators were identified by a literature review and a search of international metrics. These were ranked by survey, based on ease of data accessibility and collectability and clinical relevance. The top 27 candidates were debated by the stakeholder group and culled to a final set of 16 indicators. A user manual was created with indicators mapped to clinical codes. The indicator set was ratified by the Clinical Oncology Society of Australia and is now available for use by health care organisations participating in the ACHS Clinical Indicator Program. This inaugural cancer clinical indicator set covers high level assessment of various critical processes in cancer service provision in Australia. Regular reviews and updates will ensure usability. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT This is the inaugural indicator set for cancer care for use across Australia and internationally under the ACHS Clinical Indicator Program. Multidisciplinary involvement through a modified Delphi process selected indicators representing both generic and specific aspects of care across the cancer journey pathway and will provide a functional tool to compare health care delivery across multiple settings. It is anticipated that this will drive continual improvement in cancer care provision.
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Affiliation(s)
- Eva Segelov
- Monash University, Melbourne, VIC.,Monash Health, Melbourne, VIC
| | | | | | | | | | - Alexander G Heriot
- Epworth HealthCare, Melbourne, VIC.,Peter MacCallum Cancer Centre, Melbourne, VIC
| | | | | | - Jeremy L Millar
- Monash University, Melbourne, VIC.,Alfred Health, Melbourne, VIC
| | - Brian T Collopy
- CQM Consultants, Melbourne, VIC.,Australian Council on Healthcare Standards, Sydney, NSW
| | | | - Phoebe Zhang
- Australian Council on Healthcare Standards, Sydney, NSW
| | - Simon Cooper
- Australian Council on Healthcare Standards, Sydney, NSW
| | - Carmel O'Kane
- Wimmera Cancer Centre, Wimmera Health Care Group, Horsham, VIC
| | - Janet Wale
- Australian Council on Healthcare Standards, Sydney, NSW
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Ellis LA, Blakely B, Hazell P, Woolfenden S, Hiscock H, Sarkozy V, Gould B, Hibbert PD, Arnolda G, Ting HP, Wiles LK, Molloy CJ, Churruca K, Warwick M, Braithwaite J. Guideline adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states. PLoS One 2021; 16:e0245916. [PMID: 33556083 PMCID: PMC7869992 DOI: 10.1371/journal.pone.0245916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/08/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess General Practitioner (GP) and pediatrician adherence to clinical practice guidelines (CPGs) for diagnosis, treatment and management of attention deficit hyperactivity disorder (ADHD). METHOD Medical records for 306 children aged ≤15 years from 46 GP clinics and 20 pediatric practices in Australia were reviewed against 34 indicators derived from CPG recommendations. At indicator level, adherence was estimated as the percentage of indicators with 'Yes' or 'No' responses for adherence, which were scored 'Yes'. This was done separately for GPs, pediatricians and overall; and weighted to adjust for sampling processes. RESULTS Adherence with guidelines was high at 83.6% (95% CI: 77.7-88.5) with pediatricians (90.1%; 95% CI: 73.0-98.1) higher than GPs (68.3%; 95% CI: 46.0-85.8; p = 0.02). Appropriate assessment for children presenting with signs or symptoms of ADHD was undertaken with 95.2% adherence (95% CI: 76.6-99.9), however ongoing reviews for children with ADHD prescribed stimulant medication was markedly lower for both pediatricians (51.1%; 95% CI: 9.6-91.4) and GPs (18.7%; 95% CI: 4.1-45.5). CONCLUSION Adherence to CPGs for ADHD by pediatricians was generally high. Adherence by GPs was lower across most domains; timely recognition of medication side effects is a particular area for improvement.
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Affiliation(s)
- Louise A. Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Brette Blakely
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Philip Hazell
- Discipline of Psychiatry, School of Medicine, University of Sydney, Camperdown, New South Wales, Australia
| | - Sue Woolfenden
- School of Women and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Harriet Hiscock
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Vanessa Sarkozy
- Tumbatin Developmental Clinic, Sydney Children’s Hospital Network, School of Women and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Bronwyn Gould
- General Practitioner, Paddington, New South Wales, Australia
| | - Peter D. Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hsuen P. Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise K. Wiles
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Charlotte J. Molloy
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Meagan Warwick
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- * E-mail:
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Arnolda G, Hibbert P, Ting HP, Molloy C, Wiles L, Warwick M, Snelling T, Homaira N, Jaffe A, Braithwaite J. Assessing the appropriateness of paediatric antibiotic overuse in Australian children: a population-based sample survey. BMC Pediatr 2020; 20:185. [PMID: 32331515 PMCID: PMC7181474 DOI: 10.1186/s12887-020-02052-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/26/2020] [Indexed: 01/02/2023] Open
Abstract
Background Infections caused by antibiotic resistant pathogens are increasing, with antibiotic overuse a key contributing factor. Objective The CareTrack Kids (CTK) team assessed the care of children in Australia aged 0–15 years in 2012 and 2013 to determine the proportion of care in line with clinical practice guidelines (CPGs) for 17 common conditions. This study analyses indicators relating to paediatric antibiotic overuse to identify those which should be prioritised by antimicrobial stewardship and clinical improvement programs. Method A systematic search was undertaken for national and international CPGs relevant to 17 target conditions for Australian paediatric care in 2012–2013. Recommendations were screened and ratified by reviewers. The sampling frame comprised three states containing 60% of the Australian paediatric population (South Australia, New South Wales and Queensland). Multi-stage cluster sampling was used to select general practices, specialist paediatric practices, emergency departments and hospital inpatient services, and medical records within these. Medical records were reviewed by experienced paediatric nurses, trained to assess eligibility for indicator assessment and compliance with indicators. Adherence rates were estimated. Results Ten antibiotic overuse indicators were identified; three for tonsillitis and one each for seven other conditions. A total of 2621 children were assessed. Estimated adherence for indicators ranged from 13.8 to 99.5% while the overall estimate of compliance was 61.9% (95% CI: 47.8–74.7). Conditions with high levels of appropriate avoidance of antibiotics were gastroenteritis and atopic eczema without signs of infection, bronchiolitis and croup. Indicators with less than 50% adherence were asthma exacerbation in children aged > 2 years (47.1%; 95% CI: 33.4–61.1), sore throat with no other signs of tonsillitis (40.9%; 95% CI: 16.9, 68.6), acute otitis media in children aged > 12 months who were mildly unwell (13.8%; 95% CI: 5.1, 28.0), and sore throat and associated cough in children aged < 4 years (14.3%; 95% CI: 9.9, 19.7). Conclusion The results of this study identify four candidate indicators (two for tonsillitis, one for otitis media and one for asthma) for monitoring by antibiotic stewardship and clinical improvement programs in ambulatory and hospital paediatric care, and intervention if needed.
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Affiliation(s)
- Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, New South Wales, 2109, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, New South Wales, 2109, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, New South Wales, 2109, Australia
| | - Charli Molloy
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Louise Wiles
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Meagan Warwick
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, New South Wales, 2109, Australia
| | - Tom Snelling
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Nusrat Homaira
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Respiratory Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, New South Wales, 2109, Australia.
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10
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Long JC, Dalton S, Arnolda G, Ting HP, Molloy CJ, Hibbert PD, Wiles LK, Craig S, Warwick M, Churruca K, Ellis LA, Braithwaite J. Guideline adherence in the management of head injury in Australian children: A population-based sample survey. PLoS One 2020; 15:e0228715. [PMID: 32045446 PMCID: PMC7012413 DOI: 10.1371/journal.pone.0228715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Head injuries in children are a common and potentially devastating presentation. The CareTrack Kids (CTK) study assessed care of Australian children aged 0-15 years, in 2012 and 2013, to evaluate the proportion in line with guideline-based indicators for 17 common conditions. Overall adherence to guideline-based recommended practice occurred 59.8% of care encounters (95% CI: 57.5-62.0), and 78.3% (95% CI: 75.1-81.2) for head injury. This paper presents results for head injury, at indicator level. METHODS A modified version of the RAND-UCLA method of indicator development was used. Indicators, measurable components of a standard or guideline, were developed from international and national guidelines relating to head injury in children and were ratified by clinical experts using a Delphi process. Paediatric nurses extracted data from medical records from general practitioners (GPs), emergency departments (EDs) and inpatient wards in Queensland, New South Wales and South Australia, for children under 15 years receiving care in 2012-13. Our purpose was to estimate the percentage adherent for each indicator. RESULTS The medical records of 629 children with head injury were examined. Fifty-one percent of children were under 5 years old, with more males (61%) than females. Thirty-eight indicators were assessed. Avoidance of nasotracheal airways (100%; 95% CI: 99.4-100) or nasogastric tubes (99.7%; 95% CI: 98.5-100) for children with a head injury had the highest adherence. Indicators relating to primary and secondary assessment of head injuries were mostly adhered to. However, adherence to other indicators was poor (e.g., documentation of the past history of children (e.g., presence or absence of seizures) before the injury; 29.9% (95% CI: 24.5-35.7)), and for others was difficult to estimate with confidence due to small sample sizes (e.g., Children with a head injury who were intubated had PaO2 above 80mm Hg; 56.0% (95% CI: 28.6-80.9)). Indicators guiding clinical decision making regarding the need for CT scan had insufficient data to justify reporting. CONCLUSION This study highlights that management of head injury in children mostly follows guidelines, but also flags some specific areas of inconsistency. Individual sites are encouraged to use these results to guide investigation of local practices and inform quality improvement endeavours.
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Affiliation(s)
- Janet C. Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Dalton
- Emergency Department, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Agency for Clinical Innovation, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hsuen P. Ting
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Charlotte J. Molloy
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Peter D. Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Louise K. Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Simon Craig
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Meagan Warwick
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A. Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- * E-mail:
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11
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Wiles LK, de Wet C, Dalton C, Murphy E, Harris MF, Hibbert PD, Molloy CJ, Arnolda G, Ting HP, Braithwaite J. The quality of preventive care for pre-school aged children in Australian general practice. BMC Med 2019; 17:218. [PMID: 31805928 PMCID: PMC6896286 DOI: 10.1186/s12916-019-1455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/28/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Variable and poor care quality are important causes of preventable patient harm. Many patients receive less than recommended care, but the extent of the problem remains largely unknown. The CareTrack Kids (CTK) research programme sought to address this evidence gap by developing a set of indicators to measure the quality of care for common paediatric conditions. In this study, we focus on one clinical area, 'preventive care' for pre-school aged children. Our objectives were two-fold: (i) develop and validate preventive care quality indicators and (ii) apply them in general medical practice to measure adherence. METHODS Clinical experts (n = 6) developed indicator questions (IQs) from clinical practice guideline (CPG) recommendations using a multi-stage modified Delphi process, which were pilot tested in general practice. The medical records of Australian children (n = 976) from general practices (n = 80) in Queensland, New South Wales and South Australia identified as having a consultation for one of 17 CTK conditions of interest were retrospectively reviewed by trained paediatric nurses. Statistical analyses were performed to estimate percentage compliance and its 95% confidence intervals. RESULTS IQs (n = 43) and eight care 'bundles' were developed and validated. Care was delivered in line with the IQs in 43.3% of eligible healthcare encounters (95% CI 30.5-56.7). The bundles of care with the highest compliance were 'immunisation' (80.1%, 95% CI 65.7-90.4), 'anthropometric measurements' (52.7%, 95% CI 35.6-69.4) and 'nutrition assessments' (38.5%, 95% CI 24.3-54.3), and lowest for 'visual assessment' (17.9%, 95% CI 8.2-31.9), 'musculoskeletal examinations' (24.4%, 95% CI 13.1-39.1) and 'cardiovascular examinations' (30.9%, 95% CI 12.3-55.5). CONCLUSIONS This study is the first known attempt to develop specific preventive care quality indicators and measure their delivery to Australian children in general practice. Our findings that preventive care is not reliably delivered to all Australian children and that there is substantial variation in adherence with the IQs provide a starting point for clinicians, researchers and policy makers when considering how the gap between recommended and actual care may be narrowed. The findings may also help inform the development of specific improvement interventions, incentives and national standards.
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Affiliation(s)
- Louise K Wiles
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Carl de Wet
- Healthcare Improvement Unit, Clinical Excellence Division, Queensland Health, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | | | - Elisabeth Murphy
- New South Wales Ministry of Health, North Sydney, Sydney, NSW, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia.
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12
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Zurynski Y, Churruca K, Arnolda G, Dalton S, Ting HP, Hibbert PD, Molloy C, Wiles LK, de Wet C, Braithwaite J. Quality of care for acute abdominal pain in children. BMJ Qual Saf 2019; 29:509-516. [PMID: 31776200 PMCID: PMC7286043 DOI: 10.1136/bmjqs-2019-010088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/04/2019] [Accepted: 11/10/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess quality of care for children presenting with acute abdominal pain using validated indicators. DESIGN Audit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages. SETTING AND PARTICIPANTS Medical records of children aged 1-15 years receiving care in 2012-2013 were sampled from 57 general practitioners, 34 emergency departments (ED) and 28 hospitals across three Australian states; 6689 medical records were screened for visits for acute abdominal pain and audited by trained paediatric nurses. OUTCOME MEASURES Adherence to 21 care quality indicators and three bundles of indicators: bundle A-History; bundle B-Examination; bundle C-Imaging. RESULTS Five hundred and fourteen children had 696 visits for acute abdominal pain and adherence was assessed for 9785 individual indicators. The overall adherence was 69.9% (95% CI 64.8% to 74.6%). Adherence to individual indicators ranged from 21.6% for assessment of dehydration to 91.4% for appropriate ordering of imaging. Adherence was low for bundle A-History (29.4%) and bundle B-Examination (10.2%), and high for bundle C-Imaging (91.4%). Adherence to the 21 indicators overall was significantly lower in general practice (62.7%, 95% CI 57.0% to 68.1%) compared with ED (86.0%, 95% CI 83.4% to 88.4%; p<0.0001) and hospital inpatient settings (87.9%, 95% CI 83.1% to 91.8%; p<0.0001). CONCLUSIONS There was considerable variation in care quality for indicator bundles and care settings. Future work should explore how validated care quality indicator assessments can be embedded into clinical workflows to support continuous care quality improvement.
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Affiliation(s)
- Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,NHMRC Partnership Centre in Health System Sustainability, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Dalton
- Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter Damian Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Division of Health Sciences, Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), Adelaide, South Australia, Australia
| | - Charlotte Molloy
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Division of Health Sciences, Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), Adelaide, South Australia, Australia
| | - Louise K Wiles
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Division of Health Sciences, Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), Adelaide, South Australia, Australia
| | - Carl de Wet
- Healthcare Improvement Unit, Queensland Government Clinical Excellence Division, Brisbane, Queensland, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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13
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Sunderland N, Westbrook J, Urwin R, Knights Z, Taitz J, Williams H, Wiles LK, Molloy C, Hibbert P, Ting HP, Churruca K, Arnolda G, Braithwaite J. Appropriate management of acute gastroenteritis in Australian children: A population-based study. PLoS One 2019; 14:e0224681. [PMID: 31697706 PMCID: PMC6837505 DOI: 10.1371/journal.pone.0224681] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/18/2019] [Indexed: 11/18/2022] Open
Abstract
Objectives To determine the proportion of care provided to children with acute gastroenteritis (AGE) in Australia consistent with clinical practice guidelines. Methods Indicators were developed from national and international clinical practice guideline (CPG) recommendations and validated by an expert panel. Medical records from children ≤15 years presenting with AGE in three healthcare settings–Emergency Department (ED), hospital admissions and General Practitioner (GP) consultations–from randomly selected health districts across three Australian States were reviewed. Records were audited against 35 indicators by trained paediatric nurses, to determine adherence to CPGs during diagnosis, treatment, and ongoing management. Results A total of 14,434 indicator assessments were performed from 854 healthcare visits for AGE by 669 children, across 75 GPs, 34 EDs and 26 hospital inpatient services. Documented adherence to guidelines across all healthcare settings was 45.5% for indicators relating to diagnosis (95% CI: 40.7–50.4), 96.1% for treatment (95% CI: 94.8–97.1) and 57.6% for ongoing management (95% CI: 51.3–63.7). Adherence varied by healthcare setting, with adherence in GPs (54.6%; 95% CI: 51.1–58.1) lower than for either ED settings (84.7%; 95% CI: 82.4–86.9) or for inpatients (84.3%; 95% CI: 80.0–87.9); p<0.0001 for both differences. The difference between settings was driven by differences in the diagnosis and ongoing management phases of care. Conclusions Adherence to clinical guidelines for children presenting to healthcare providers with AGE varies according to phase of care and healthcare setting. Although appropriate diagnostic assessment and ongoing management phase procedures are not well documented in medical records (particularly in the GP setting), in the treatment phase children are treated in accordance with guidelines over 90% of the time.
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Affiliation(s)
- Neroli Sunderland
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Rachel Urwin
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Zoe Knights
- Emergency Department, The Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Jonny Taitz
- Clinical Excellence Commission, McKell Building, Sydney, NSW, Australia
| | - Helena Williams
- Australian Commission on Safety and Quality in Health Care, Women’s and Children’s Hospital, SALHN, Adelaide, SA, Australia
| | - Louise K. Wiles
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Charlotte Molloy
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Peter Hibbert
- Australian Centre for Precision Health, University of South Australia Cancer Research Institute (UniSA CRI), School of Health Sciences, University of South Australia, Adelaide, SA, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Hsuen P. Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
- * E-mail:
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14
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Ellis LA, Wiles LK, Selig R, Churruca K, Lingam R, Long JC, Molloy CJ, Arnolda G, Ting HP, Hibbert P, Dowton SB, Braithwaite J. Assessing the quality of care for paediatric depression and anxiety in Australia: A population-based sample survey. Aust N Z J Psychiatry 2019; 53:1013-1025. [PMID: 31394909 DOI: 10.1177/0004867419866512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We examine the prevalence of quality care (as measured by adherence to recommendations in clinical practice guidelines) for Australian paediatric patients (⩽15 years) with depression and/or anxiety, using data from the CareTrack Kids study; a population-based study of the quality of healthcare practice in inpatient and ambulatory healthcare settings. METHODS A multistage stratified sample identified records of 6689 children. Of these, 156 records were identified for depression and 356 for anxiety. These were assessed for adherence to 15 depression and 13 anxiety indicators, respectively, using a review of medical records. RESULTS Adherence to assessment and management guidelines was low for both conditions: assessment bundle (depression = 33%, 95% confidence interval = [20, 48]; anxiety = 54%, 95% confidence interval = [43, 64] and depression management bundle = 35%, 95% confidence interval = [15, 60]). Across both conditions, the highest adherence was recorded for indicators that addressed prescription of medications (e.g. venlafaxine, 100%; benzodiazepines, 100%; selective serotonin reuptake inhibitor, 94% and antidepressants, 91%), while compliance was the lowest for ensuring children with depression had an emergency safety plan (44%), informing parents of the risks and benefits of prescribed anxiety medication (51%) and assessment for other causes (59% for depression; 68% for anxiety). CONCLUSION These findings suggest that strategies are needed to improve guideline adherence for mental health disorders in children and adolescents, particularly among general practitioners. Learning from these indicators could inform clinical prompts in electronic medical records, as well as links to additional information, to assist in decision-making and streamline work practices.
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Affiliation(s)
- Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Louise K Wiles
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Ruth Selig
- Paediatric Medicine and Child and Adolescent Mental Health, Family in Mind, Mosman, NSW, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Women's and Children's Health, UNSW Medicine and Sydney Children's Hospitals Network, Sydney, NSW, Australia
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Charlotte J Molloy
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Hsuen P Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia.,Australian Centre for Precision Health, University of South Australia Cancer Research Institute, University of South Australia, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - S Bruce Dowton
- Office of Vice-Chancellor, Macquarie University, Sydney, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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15
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Churruca K, Ellis LA, Long JC, Pomare C, Wiles LK, Arnolda G, Ting HP, Woolfenden S, Sarkozy V, de Wet C, Hibbert P, Braithwaite J. The Quality of Care for Australian Children with Autism Spectrum Disorders. J Autism Dev Disord 2019; 49:4919-4928. [PMID: 31473948 DOI: 10.1007/s10803-019-04195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Knowledge about the quality of care delivered to children with autism spectrum disorders (ASD) in relation to that recommended by clinical practice guidelines (CPGs) is limited. ASD care quality indicators were developed from CPGs and validated by experts, then used to assess the quality of care delivered by general practitioners (GPs) and pediatricians in Australia. Data were retrospectively collected from the medical records of 228 children (≤ 15 years) with ASD for 2012-2013. Overall quality of care was high, but with considerable variation among indicators, and between GPs and pediatricians-e.g., GPs were less likely to complete the assessment care bundle (61%; 95% CI 21-92). Findings highlight potential areas for improvement in the need for standardized criteria for diagnosis.
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Affiliation(s)
- K Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.
| | - L A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - J C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - C Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - L K Wiles
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.,Australian Centre for Precision Health, School of Health Sciences, University of South Australia Cancer Research Institute, University of South Australia, Level 8, North Terrace, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - G Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - H P Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
| | - S Woolfenden
- Department of Community Child Health, Sydney Children's Hospitals Network, School of Women and Children's Health, University of New South Wales, Sydney Children's Hospital, Level 3, High Street, Randwick, NSW, 2031, Australia
| | - V Sarkozy
- Tumbatin Developmental Clinic, Sydney Children's Hospital Network, School of Women and Children's Health, University of New South Wales, Sydney Children's Hospital, High Street, Randwick, NSW, 2031, Australia
| | - C de Wet
- Healthcare Improvement Unit, Clinical Excellence Division, Queensland Health, Brisbane, Australia.,School of Medicine, Griffith University, Gold Coast, Gold Coast Campus, Brisbane, QLD, 4222, Australia
| | - P Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia.,Australian Centre for Precision Health, School of Health Sciences, University of South Australia Cancer Research Institute, University of South Australia, Level 8, North Terrace, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - J Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, North Ryde, NSW, 2109, Australia
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Long JC, Williams HM, Jani S, Arnolda G, Ting HP, Molloy CJ, Hibbert PD, Churruca K, Ellis LA, Braithwaite J. Assessing the appropriateness of the management of upper respiratory tract infection in Australian children: a population-based sample survey. BMJ Open 2019; 9:e026915. [PMID: 31092659 PMCID: PMC6530449 DOI: 10.1136/bmjopen-2018-026915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To assess the proportion of Australian children aged 0-15 years that received care in line with clinical practice guidelines (CPGs) for upper respiratory tract infections (URTIs). DESIGN Retrospective medical record review using a multistage sampling strategy. SETTING General practices, hospital emergency departments and hospital inpatient service providers in three Australian states. PARTICIPANTS Children aged up to 15 years who received care for URTI in 2012 and 2013. PRIMARY AND SECONDARY OUTCOME MEASURES The primary assessment was estimated adherence with 14 indicators of appropriate care as documented in medical records. Indicators were extracted from national and international CPGs and ratified by experts. Secondary assessment was adherence to two bundles of indicators (diagnostic symptoms and medical history taking), where all indicators must be adherent for the bundle to be scored as adherent. RESULTS There were 1653 children with one or more assessments of URTI care to CPG adherence. Over half of the children were under 3 years of age, with roughly equal numbers of males and females. Three indicators had fewer than 25 visits so were not reported. Overall adherence ranged from 0.5% for 'documented advice around antibiotics' to 88.3% for 'documentation of medical history'. Adherence with Bundle A (documentation of all three definitive symptoms) was 43.1% (95% CI 32.8% to 54.0%) and Bundle B (documentation of all four indicators of medical history) was 30.2% (95% CI 20.9% to 40.9%). CONCLUSIONS URTIs in children are common, usually self-limiting, conditions that are allocated considerable resources. The results suggest that there may be a need for more thorough holistic assessment of the patient and improved documentation. Since inappropriate prescription of antibiotics for URTIs is still a known problem in Australia, there is a need for consistent, clear communication around antibiotics' lack of impact on symptoms and a high association with undesirable side effects.
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Affiliation(s)
- Janet C Long
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
| | | | - Shefali Jani
- Emergency Department, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
| | - Hsuen P Ting
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
- Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
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