Developing a set of consensus indicators to support maternity service quality improvement: using Core Outcome Set methodology including a Delphi process

Bunch, KJ; Allin, Benjamin; Jolly, Matthew; Hardie, Thomas; Knight, Marian

doi:10.1111/1471-0528.15282

Cited by 28 publications

(31 citation statements)

References 13 publications

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“…A Delphi process is a well established method for achieving consensus from multiple groups of stakeholders, 10 and has been used in health care for many purposes, including development of core outcome sets and identification of measures for monitoring quality of care. [11][12][13][14][15] Broadly, a Delphi process involves asking respondents to complete sequential questionnaires with group opinion relayed to individual participants between completion of the questionnaires. Children with PIMS-TS require the expertise of clinicians who specialise in immunology, infectious diseases, respiratory medicine, rheumatology, cardiology, intensive care, general paediatrics, haematology, and, in some cases, surgery, radiology, and neurology.…”

Section: Introductionmentioning

confidence: 99%

A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process

Harwood

Allin

Jones

et al. 2021

The Lancet Child & Adolescent Health

280

316

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Paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a novel condition that was first reported in April, 2020. We aimed to develop a national consensus management pathway for the UK to provide guidance for clinicians caring for children with PIMS-TS. A three-phase online Delphi process and virtual consensus meeting sought consensus over the investigation, management, and research priorities from multidisciplinary clinicians caring for children with PIMS-TS. We used 140 consensus statements to derive a consensus management pathway that describes the initial investigation of children with suspected PIMS-TS, including blood markers to help determine the severity of disease, an echocardiogram, and a viral and septic screen to exclude other infectious causes of illness. The importance of a multidisciplinary team in decision making for children with PIMS-TS is highlighted throughout the guidance, along with the recommended treatment options, including supportive care, intravenous immunoglobulin, methylprednisolone, and biological therapies. These include IL-1 antagonists (eg, anakinra), IL-6 receptor blockers (eg, tocilizumab), and anti-TNF agents (eg, infliximab) for children with Kawasaki disease-like phenotype and non-specific presentations. Use of a rapid online Delphi process has made it possible to generate a national consensus pathway in a timely and cost-efficient manner in the middle of a global pandemic. The consensus statements represent the views of UK clinicians and are applicable to children in the UK suspected of having PIMS-TS. Future evidence will inform updates to this guidance, which in the interim provides a solid framework to support clinicians caring for children with PIMS-TS. This process has directly informed new PIMS-TS specific treatment groups as part of the adaptive UK RECOVERY trial protocol, which is the first formal randomised controlled trial of therapies for PIMS-TS globally.

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Section: Introductionmentioning

confidence: 99%

A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process

Harwood

Allin

Jones

et al. 2021

The Lancet Child & Adolescent Health

280

316

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“…There were six indicators with feasibility concerns: no. 14 Table 1. List of original 35 care quality indicators.…”

Section: Resultsmentioning

confidence: 99%

Applicability of care quality indicators for women with low-risk pregnancies planning hospital birth: a retrospective study of medical records

Ueda

Sado

Takahashi

et al. 2020

Sci Rep

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Practices for planned birth among women with low-risk pregnancies vary by birth setting, medical professional, and organizational system. Appropriate monitoring is essential for quality improvement. Although sets of quality indicators have been developed, their applicability has not been tested. To improve the quality of childbirth care for low-risk mothers and infants in Japanese hospitals, we developed 35 quality indicators using existing clinical guidelines and quality indicators. We retrospectively analysed data for 347 women in Japan diagnosed with low-risk pregnancy in the second trimester, admitted between April 2015 and March 2016. We obtained scores for 35 quality indicators and evaluated their applicability, i.e., feasibility, improvement potential, and reliability (intra-and inter-rater reliability: kappa score, positive and negative agreement). The range of adherence to each indicator was 0-95.7%. We identified feasibility concerns for six indicators with over 25% missing data. Two indicators with over 90% adherence showed limited potential for improvement. Three indicators had poor kappa scores for intra-rater reliability, with positive/negative agreement scores 0.94/0.33, 0.33/0.95, and 0.00/0.97, respectively. Two indicators had poor kappa scores for inter-rater reliability, with positive/negative agreement scores 0.25/0.92 and 0.68/0.61, respectively. The findings indicated that these 35 care quality indicators for low-risk pregnant women may be applicable to real-world practice, with some caveats. No serious differences in clinical outcomes such as infant mortality and morbidity have been reported among low-risk pregnant women giving birth at home, in a midwifery unit, or in an obstetrics unit 1-5. However, childbirth care practices for women with low-risk pregnancy vary according to birth setting, medical professional, and organizational system. Women with low risk who are planning a birth at home or in a midwifery unit are more likely to have a vaginal birth and to receive less unnecessary medical intervention than women with planned births in an obstetrics unit 6. In addition, women receiving midwife-led continuous care by the same midwife or team of midwives from pregnancy until the early parenting period report greater satisfaction 7. In all cases, it is critical to refrain from unnecessary interventions, such as caesarean sections and episiotomies 8-10. To improve quality of care, quality indicators have been widely used in many clinical fields. A quality indicator is defined as "a measurable element of practice performance for which there is evidence or consensus that it can be used to assess the quality, and hence change in the quality, of care provided" 11,12. Quality indicators for maternal and perinatal hospital care have been developed mainly for high-risk pregnancy using the consensus method 13-16 .

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“…For several years, safety at birth and the quality of care in the perinatal period have been a topic of concern to public health officials, care providers, and patient groups around the world. Accordingly, several sets of indicators assessing quality of care in obstetrics have been proposed but no consensus has emerged around any of them [1–11]. They have three principal limitations.…”

Section: Introductionmentioning

confidence: 99%

Monitoring quality of obstetric care from hospital discharge databases: A Delphi survey to propose a new set of indicators based on maternal health outcomes

et al. 2019

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Objectives Most indicators proposed for assessing quality of care in obstetrics are process indicators and do not directly measure health effects, and cannot always be identified from routinely available databases. Our objective was to propose a set of indicators to assess the quality of hospital obstetric care from maternal morbidity outcomes identifiable in permanent hospital discharge databases. Methods Various maternal morbidity outcomes potentially reflecting quality of obstetric care were first selected from a systematic literature review. Then a three-round Delphi consensus survey was conducted online from 11/2016 through 02/2017 among a French panel of 37 expert obstetricians, anesthetists-critical-care specialists, midwives, quality-of-care researchers, and user representatives. For a given maternal outcome, several definitions could be proposed and the indicator (i.e. corresponding rate) could be applied to all women or restricted to specific subgroup(s). Results Of the 49 experts invited to participate, 37 agreed. The response rate was 92% in the second round and 97% in the third. Finally, a set of 13 indicators was selected to assess the quality of hospital obstetric care: rates of uterine rupture, postpartum hemorrhage, transfusion incident, severe perineal lacerations, episiotomy, cesarean, cesarean under general anesthesia, post-cesarean site infection, anesthesia-related complications, postpartum pulmonary embolism, maternal readmission and maternal mortality. Six were considered in specific subgroups, with, for example, the postpartum hemorrhage rate assessed among all women and also among women at low risk of PPH. Implications This Delphi process enabled us to define consensually a set of indicators to assess the quality of hospital obstetrics care from routine hospital data, based on maternal morbidity outcomes. Considering 6 of them in specific subgroups of women is especially interesting. These indicators, identifiable through codes used in international classifications, will be useful to monitor quality of care over time and across settings.

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Developing a set of consensus indicators to support maternity service quality improvement: using Core Outcome Set methodology including a Delphi process

Cited by 28 publications

References 13 publications

A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process

A national consensus management pathway for paediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS): results of a national Delphi process

Applicability of care quality indicators for women with low-risk pregnancies planning hospital birth: a retrospective study of medical records

Monitoring quality of obstetric care from hospital discharge databases: A Delphi survey to propose a new set of indicators based on maternal health outcomes

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