Development of a quality indicator set to measure and improve quality of ICU care in low‑ and middle‑income countries

Pari, Vrindha and Mat Nor, Mohd Basri (2022) Development of a quality indicator set to measure and improve quality of ICU care in low‑ and middle‑income countries. Intensive Care Medicine, 48 (11). pp. 1551-1562. ISSN 0342-4642 E-ISSN 1432-1238

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Abstract

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 wellbeing, 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. Keywords: Quality indicators, Delphi technique, Resource constrained, LMIC, Critical care

Item Type:	Article (Journal)
Uncontrolled Keywords:	Critical care; Delphi technique; LMIC; Quality indicators; Resource constrained
Subjects:	R Medicine > RC Internal medicine > RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Medicine Kulliyyah of Medicine > Department of Anaesthesiology & Intensive Care
Depositing User:	Dr. Mohd Basri Mat Nor
Date Deposited:	24 Oct 2024 09:12
Last Modified:	24 Oct 2024 10:50
URI:	http://irep.iium.edu.my/id/eprint/104417

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