title: Development of quality indicators to evaluate antibiotic treatment of patients with community-acquired pneumonia in Indonesia.
abstract: OBJECTIVE
  To develop an instrument for evaluating the quality of antibiotic management of patients with community-acquired pneumonia (CAP) applicable in a middle-income developing country.
  
  
  METHODS
  A previous study and Indonesian guidelines were reviewed to derive potential quality of care indicators (QIs). An expert panel performed a two-round Delphi consensus procedure on the QI's relevance to patient recovery, reduction of antimicrobial resistance and cost containment. Applicability in practice, including reliability, feasibility and opportunity for improvement, was determined in a data set of 128 patients hospitalised with CAP in Semarang, Indonesia.
  
  
  RESULTS
  Fifteen QIs were selected by the consensus procedure. Five QIs did not pass feasibility criteria, because of inappropriate documentation, inefficient laboratory services or patient factors. Three QIs provided minor opportunity for improvement. Two QIs contradicted each other; one of these was considered not valid and excluded. A final set of six QIs was defined for use in the Indonesian setting.
  
  
  CONCLUSIONS
  Using the Delphi method, we defined a list of QIs for assessing the quality of care, in particular antibiotic treatment, for CAP in Indonesia. For further improvement, a modified Delphi method that includes discussion, a sound medical documentation system, improvement of microbiology laboratory services, and multi-center applicability tests are needed to develop a valid and applicable QI list for the Indonesian setting.
authors.affiliation: Department of Microbiology, Faculty of Medicine, Diponegoro University and Dr. Kariadi Hospital, Semarang, Indonesia.
authors.forename: Helmia
authors.initials: H
authors.lastname: Farida
authors.forename: Angelique
authors.initials: A
authors.lastname: Rondags
authors.forename: M Hussein
authors.initials: MH
authors.lastname: Gasem
authors.forename: Katharina
authors.initials: K
authors.lastname: Leong
authors.forename: A
authors.initials: A
authors.lastname: Adityana
authors.forename: Peterhans J
authors.initials: PJ
authors.lastname: van den Broek
authors.forename: Monique
authors.initials: M
authors.lastname: Keuter
authors.forename: Stephanie
authors.initials: S
authors.lastname: Natsch
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D003697:Delphi Technique; D006760:Hospitalization; D006801:Humans; D007214:Indonesia; D010043:Outcome and Process Assessment, Health Care; D011014:Pneumonia / Q000188:drug therapy*; D019984:Quality Indicators, Health Care
chemical_list: D000900:Anti-Bacterial Agents
keywords: Delphi method; Indonesia; Indonésie; adultes; adultos; adults; antibiotic treatment, Indonesia; community-acquired pneumonia; indicador de calidad; indicateurs de qualité; méthode Delphi; método Delphi; neumonía adquirida en la comunidad; pneumonie acquise dans la communauté; quality indicator; traitement antibiotique; tratamiento antibiótico