Quality Indicators in Paediatric and Perinatal Care in Japan: Development and Feasibility Testing

Abstract

Purpose Few paediatric and perinatal quality indicators (QIs) have been developed in the Japanese setting, and the quality of care is not assured or validated. The aim of this study was to develop QIs in paediatric and perinatal care in Japan using an administrative database and confirm the feasibility and applicability of the indicators using a single-site practice test. Methods We used a RAND-modified Delphi method that integrates evidence review with expert consensus development. QI candidates were generated from clinical practice guidelines (CPGs) available in English or Japanese and existing QIs in nine selected paediatric or perinatal conditions. Consensus building was based on independent panel ratings. The performance of each QI was retrospectively assessed using data from an administrative database at the National Children’s Hospital. Results From the literature review conducted between 2010 and 2020, 124 CPGs and 193 existing indicators were identified to generate QI candidates. Through the consensus-building process, 133 QI candidates were assessed, and 79 QIs were accepted. The practice test revealed wide variations in the process-level performance of QIs in four categories (patient safety: median 43.9% (interquartile range (IQR) 16.7–85.6%), general paediatrics: median 98.8% (IQR 84.2–100%), advanced paediatrics: median 94.4% (IQR 46.0–100%), and advanced obstetrics: median 80.3% (IQR 59.6–100%). Conclusions We established 79 QIs for paediatric and perinatal care in Japan using an administrative database that can be applied to hospitals nationwide. The practice test confirmed the measurability of the developed QIs. Benchmarking these QIs will be an attractive approach to improving the quality of paediatric and perinatal care.