TY - JOUR
T1 - Development of a quality indicator set to measure and improve quality of ICU care in low- and middle-income countries
AU - Collaboration for Research Implementation, Training in Critical Care, Asia Africa ‘CCAA’
AU - Pari, Vrindha
AU - Sluijs, Eva Fleur
AU - del Pilar Arias López, Maria
AU - Thomson, David Alexander
AU - Tripathy, Swagata
AU - Vengadasalam, Sutharshan
AU - Vijayaraghavan, Bharath Kumar Tirupakuzhi
AU - Pisani, Luigi
AU - de Keizer, Nicolette
AU - Adhikari, Neill K.J.
AU - Pilcher, David
AU - Inglis, Rebecca
AU - Bulamba, Fred
AU - Dondorp, Arjen M.
AU - Kooloth, Rohit Aravindakshan
AU - Phua, Jason
AU - Sendagire, Cornelius
AU - Waweru-Siika, Wangari
AU - Mazlan, Mohd Zulfakar
AU - Haniffa, Rashan
AU - Salluh, Jorge I.F.
AU - Davies, Justine
AU - Beane, Abigail
AU - Abonyo, Teddy Thaddeus
AU - Al-Saud, Najwan Abu
AU - Aryal, Diptesh
AU - Baker, Tim
AU - Belachew, Fitsum Kifle
AU - Biccard, Bruce M.
AU - Bonney, Joseph
AU - Burghi, Gaston
AU - Dongelmans, Dave A.
AU - Dullewe, N. P.
AU - Faiz, Mohammad Abul
AU - Fernandez, Mg Ariel
AU - siaw-frimpong, Moses
AU - Gallesio, Antonio
AU - Ghalib, Maryam Shamal
AU - Hashmi, Madiha
AU - Kayambankadzanja, Raphael Kazidule
AU - Kwizera, Arthur
AU - Luitel, Subekshya
AU - Moonesinghe, Ramani
AU - Nor, Mohd Basri Mat
AU - Paneru, Hem Raj
AU - Priyadarshani, Dilanthi
AU - Shaikh, Mohiuddin
AU - Srisawat, Nattachai
AU - Wijekoon, W. M.Ashan
AU - Yen, Lam Minh
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/11
Y1 - 2022/11
N2 - Purpose: To develop a set of actionable quality indicators for critical care suitable for use in low- or middle-income countries (LMICs). Methods: A list of 84 candidate indicators compiled from a previous literature review and stakeholder recommendations were categorised into three domains (foundation, process, and quality impact). An expert panel (EP) representing stakeholders from critical care and allied specialties in multiple low-, middle-, and high-income countries was convened. In rounds one and two of the Delphi exercise, the EP appraised (Likert scale 1–5) each indicator for validity, feasibility; in round three sensitivity to change, and reliability were additionally appraised. Potential barriers and facilitators to implementation of the quality indicators were also reported in this round. Median score and interquartile range (IQR) were used to determine consensus; indicators with consensus disagreement (median < 4, IQR ≤ 1) were removed, and indicators with consensus agreement (median ≥ 4, IQR ≤ 1) or no consensus were retained. In round four, indicators were prioritised based on their ability to impact cost of care to the provider and recipient, staff well-being, patient safety, and patient-centred outcomes. Results: Seventy-one experts from 30 countries (n = 45, 63%, representing critical care) selected 57 indicators to assess quality of care in intensive care unit (ICU) in LMICs: 16 foundation, 27 process, and 14 quality impact indicators after round three. Round 4 resulted in 14 prioritised indicators. Fifty-seven respondents reported barriers and facilitators, of which electronic registry-embedded data collection was the biggest perceived facilitator to implementation (n = 54/57, 95%) Concerns over burden of data collection (n = 53/57, 93%) and variations in definition (n = 45/57, 79%) were perceived as the greatest barrier to implementation. Conclusion: This consensus exercise provides a common set of indicators to support benchmarking and quality improvement programs for critical care populations in LMICs.
AB - Purpose: To develop a set of actionable quality indicators for critical care suitable for use in low- or middle-income countries (LMICs). Methods: A list of 84 candidate indicators compiled from a previous literature review and stakeholder recommendations were categorised into three domains (foundation, process, and quality impact). An expert panel (EP) representing stakeholders from critical care and allied specialties in multiple low-, middle-, and high-income countries was convened. In rounds one and two of the Delphi exercise, the EP appraised (Likert scale 1–5) each indicator for validity, feasibility; in round three sensitivity to change, and reliability were additionally appraised. Potential barriers and facilitators to implementation of the quality indicators were also reported in this round. Median score and interquartile range (IQR) were used to determine consensus; indicators with consensus disagreement (median < 4, IQR ≤ 1) were removed, and indicators with consensus agreement (median ≥ 4, IQR ≤ 1) or no consensus were retained. In round four, indicators were prioritised based on their ability to impact cost of care to the provider and recipient, staff well-being, patient safety, and patient-centred outcomes. Results: Seventy-one experts from 30 countries (n = 45, 63%, representing critical care) selected 57 indicators to assess quality of care in intensive care unit (ICU) in LMICs: 16 foundation, 27 process, and 14 quality impact indicators after round three. Round 4 resulted in 14 prioritised indicators. Fifty-seven respondents reported barriers and facilitators, of which electronic registry-embedded data collection was the biggest perceived facilitator to implementation (n = 54/57, 95%) Concerns over burden of data collection (n = 53/57, 93%) and variations in definition (n = 45/57, 79%) were perceived as the greatest barrier to implementation. Conclusion: This consensus exercise provides a common set of indicators to support benchmarking and quality improvement programs for critical care populations in LMICs.
KW - Critical care
KW - Delphi technique
KW - LMIC
KW - Quality indicators
KW - Resource constrained
UR - http://www.scopus.com/inward/record.url?scp=85138153991&partnerID=8YFLogxK
U2 - 10.1007/s00134-022-06818-7
DO - 10.1007/s00134-022-06818-7
M3 - Article
C2 - 36112158
AN - SCOPUS:85138153991
SN - 0342-4642
VL - 48
SP - 1551
EP - 1562
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 11
ER -