title: Development of paediatric quality of inpatient care indicators for low-income countries - A Delphi study.
abstract: BACKGROUND
  Indicators of quality of care for children in hospitals in low-income countries have been proposed, but information on their perceived validity and acceptability is lacking.
  
  
  METHODS
  Potential indicators representing structural and process aspects of care for six common conditions were selected from existing, largely qualitative WHO assessment tools and guidelines. We employed the Delphi technique, which combines expert opinion and existing scientific information, to assess their perceived validity and acceptability. Panels of experts, one representing an international panel and one a national (Kenyan) panel, were asked to rate the indicators over 3 rounds and 2 rounds respectively according to a variety of attributes.
  
  
  RESULTS
  Based on a pre-specified consensus criteria most of the indicators presented to the experts were accepted: 112/137(82%) and 94/133(71%) for the international and local panels respectively. For the other indicators there was no consensus; none were rejected. Most indicators were rated highly on link to outcomes, reliability, relevance, actionability and priority but rated more poorly on feasibility of data collection under routine conditions. There was moderate to substantial agreement between the two panels of experts.
  
  
  CONCLUSIONS
  This Delphi study provided evidence for the perceived usefulness of most of a set of measures of quality of hospital care for children proposed for use in low-income countries. However, both international and local experts expressed concerns that data for many process-based indicators may not currently be available. The feasibility of widespread quality assessment and responsiveness of indicators to intervention should be examined as part of continued efforts to improve approaches to informative hospital quality assessment.
authors.affiliation: Kenya Medical Research Institute/Wellcome Trust Centre for Geographic Medicine Research, Kilifi, Kenya. sntoburi@nairobi.kemri-wellcome.org
authors.forename: Stephen
authors.initials: S
authors.lastname: Ntoburi
authors.forename: Andrew
authors.initials: A
authors.lastname: Hutchings
authors.forename: Colin
authors.initials: C
authors.lastname: Sanderson
authors.forename: James
authors.initials: J
authors.lastname: Carpenter
authors.forename: Martin
authors.initials: M
authors.lastname: Weber
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D002648:Child; D002673:Child, Hospitalized; D003697:Delphi Technique; D003906:Developing Countries / Q000191:economics*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D010372:Pediatrics / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000639:trends; D014944:World Health Organization / Q000458:organization & administration