Dataset Information

Clinical indicators for common paediatric conditions: Processes, provenance and products of the CareTrack Kids study.

ABSTRACT: BACKGROUND:In order to determine the extent to which care delivered to children is appropriate (in line with evidence-based care and/or clinical practice guidelines (CPGs)) in Australia, we developed a set of clinical indicators for 21 common paediatric medical conditions for use across a range of primary, secondary and tertiary healthcare practice facilities. METHODS:Clinical indicators were extracted from recommendations found through systematic searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts reviewed the indicators using a multi-round modified Delphi process and collaborative online wiki to develop consensus on what constituted appropriate care. RESULTS:From 121 clinical practice guidelines, 1098 recommendations were used to draft 451 proposed appropriateness indicators. In total, 61 experts (n = 24 internal reviewers, n = 37 external reviewers) reviewed these indicators over 40 weeks. A final set of 234 indicators resulted, from which 597 indicator items were derived suitable for medical record audit. Most indicator items were geared towards capturing information about under-use in healthcare (n = 551, 92%) across emergency department (n = 457, 77%), hospital (n = 450, 75%) and general practice (n = 434, 73%) healthcare facilities, and based on consensus level recommendations (n = 451, 76%). The main reason for rejecting indicators was 'feasibility' (likely to be able to be used for determining compliance with 'appropriate care' from medical record audit). CONCLUSION:A set of indicators was developed for the appropriateness of care for 21 paediatric conditions. We describe the processes (methods), provenance (origins and evolution of indicators) and products (indicator characteristics) of creating clinical indicators within the context of Australian healthcare settings. Developing consensus on clinical appropriateness indicators using a Delphi approach and collaborative online wiki has methodological utility. The final indicator set can be used by clinicians and organisations to measure and reflect on their own practice.

SUBMITTER: Wiles LK

PROVIDER: S-EPMC6326465 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Clinical indicators for common paediatric conditions: Processes, provenance and products of the CareTrack Kids study.

Wiles Louise K LK Hooper Tamara D TD Hibbert Peter D PD Molloy Charlotte C White Les L Jaffe Adam A Cowell Christopher T CT Harris Mark F MF Runciman William B WB Schmiede Annette A Dalton Chris C Hallahan Andrew R AR Dalton Sarah S Williams Helena H Wheaton Gavin G Murphy Elisabeth E Braithwaite Jeffrey J

PloS one 20190109 1

<h4>Background</h4>In order to determine the extent to which care delivered to children is appropriate (in line with evidence-based care and/or clinical practice guidelines (CPGs)) in Australia, we developed a set of clinical indicators for 21 common paediatric medical conditions for use across a range of primary, secondary and tertiary healthcare practice facilities.<h4>Methods</h4>Clinical indicators were extracted from recommendations found through systematic searches of national and internat ...[more]

PMID: 30625190

Similar Datasets

Project description:BackgroundCost-utility analyses are commonly used in economic evaluations of interventions or conditions that have an impact on health-related quality of life. However, evaluating utilities in children presents several challenges since young children may not have the cognitive ability to complete measurement tasks and thus utility values must be estimated by proxy assessors. Another solution is to use utilities derived from an adult population. To better inform the future conduct of cost-utility analyses in paediatric populations, we reviewed the published literature reporting utilities among children and adults across selected conditions common to paediatric and adult populations.MethodsAn electronic search of Ovid MEDLINE, EMBASE, and the Cochrane Library up to November 2008 was conducted to identify studies presenting utility values derived from the Health Utilities Index (HUI) or EuroQoL-5Dimensions (EQ-5D) questionnaires or using time trade off (TTO) or standard gamble (SG) techniques in children and/or adult populations from randomized controlled trials, comparative or non-comparative observational studies, or cross-sectional studies. The search was targeted to four chronic diseases/conditions common to both children and adults and known to have a negative impact on health-related quality of life (HRQoL).ResultsAfter screening 951 citations identified from the literature search, 77 unique studies included in our review evaluated utilities in patients with asthma (n = 25), cancer (n = 23), diabetes mellitus (n = 11), skin diseases (n = 19) or chronic diseases (n = 2), with some studies evaluating multiple conditions. Utility values were estimated using HUI (n = 33), EQ-5D (n = 26), TTO (n = 12), and SG (n = 14), with some studies applying more than one technique to estimate utility values. 21% of studies evaluated utilities in children, of those the majority being in the area of oncology. No utility values for children were reported in skin diseases. Although few studies provided comparative information on utility values between children and adults, results seem to indicate that utilities may be similar in adolescents and young adults with asthma and acne. Differences in results were observed depending on methods and proxies.ConclusionsThis review highlights the need to conduct future research regarding measurement of utilities in children.

Project description:BACKGROUND:Hospital admission, like hospital discharge, represents a transition of care associated with changes in setting, healthcare providers and clinical management. While considerable efforts have focused on improving the quality and safety of hospital-to-home transitions, there has been little focus on transitions into hospital. OBJECTIVES:Among children hospitalised with ambulatory care sensitive conditions, we aimed to characterise families' experiences as they transitioned from outpatient to inpatient care, identify hospital admission processes and outcomes most important to families and determine how parental perspectives differed between children admitted directly and through emergency departments (ED). METHODS:We conducted semistructured interviews with parents of hospitalised children at four structurally diverse hospitals. We inquired about preadmission healthcare encounters, how hospital admission decisions were made and parents' preferences regarding hospital admission processes and outcomes. Interviews were transcribed verbatim and analysed using a general inductive approach. RESULTS:We conducted 48 interviews. Participants were predominantly mothers (74%); 45% had children with chronic illnesses and 52% were admitted directly. Children had a median of two (IQR 1-3) healthcare encounters in the week preceding hospital admission, with 44% seeking care in multiple settings. Patterns of healthcare utilisation were influenced by (1) disease acuity and healthcare access; (2) past experiences; and (3) varied perspectives about primary care and ED roles as hospital gatekeepers. Participants' hospital admission priorities included: (1) effective clinical care; (2) efficient admission processes; (3) safety and security; (4) timeliness; and (5) patient and family-centred processes of care. CONCLUSIONS:Families received preadmission care in several settings and described varying degrees of care coordination during their admission processes. This research can guide improvements in hospitals' admission systems, necessary to achieve health system integration and continuity of care.

Project description:BackgroundFew studies have evaluated paediatric dermatological conditions and their associated factors that warrant admission at the emergency department.ObjectivesThe main objective of this study was to present the demographic information of paediatric dermatological conditions encountered in the emergency department and identify possible associated factors for hospital admission.MethodsThis retrospective cross-sectional study included paediatric patients who visited the emergency department between 1 January 2016 and 31 December 2019. Data collection was performed using an authorised electronic medical records programme at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.ResultsA total of 40 683 paediatric patients visited the emergency department during the study period, with 1701 cases presenting dermatological conditions. Infections were the most frequent conditions encountered in the emergency department (647, 38.0%), followed by urticaria/anaphylaxis (478, 28.1%), eczematous diseases (463, 27.2%), cutaneous drug eruptions (64, 3.7%) and miscellaneous (49, 2.9%). Among 1701 paediatric cases with dermatological conditions, only 182 cases (10.7%) were admitted to the hospital and required further management. Cases presenting cutaneous drug eruptions had the highest proportion of hospital admissions (60.9%) and were significantly different from cases in other dermatologic categories (p<0.001). The association of admission found an OR of 0.96 for every year of increase in age (95% CI 0.93 to 0.99, p=0.003).ConclusionThe present study found that the majority of patients with cutaneous conditions visiting the emergency department were non-urgent; however, dermatological emergencies exist and should not be underestimated. Younger paediatric patients presenting with dermatological condition is a population with a high risk for hospital admission. Cutaneous drug eruptions showed the highest proportion of hospital admissions compared with other dermatological categories. Therefore, physicians in the emergency department should always look for specific cutaneous signs of drug eruptions, such as target-like lesions and mucosal involvement in Steven-Johnsons syndrome/toxic epidermal necrolysis to prevent misdiagnosis of this dermatological condition.

Dataset Information

Clinical indicators for common paediatric conditions: Processes, provenance and products of the CareTrack Kids study.

Publications

Clinical indicators for common paediatric conditions: Processes, provenance and products of the CareTrack Kids study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure