title: The Paediatric Admission Quality of Care (PAQC) score: designing a tool to measure the quality of early inpatient paediatric care in a low-income setting.
abstract: BACKGROUND
  Evaluating clinician compliance with recommended steps in clinical guidelines provides one measure of quality of process of care but can result in a multiplicity of indicators across illnesses, making it problematic to produce any summative picture of process quality, information that may be most useful to policy-makers and managers.
  
  
  OBJECTIVE
  We set out to develop a clinically logical summative measure of the quality of care provided to children admitted to hospital in Kenya spanning the three diagnoses present in 60% or more of admissions that would provide a patient-level measure of quality of care in the face of comorbidity.
  
  
  METHODS
  We developed a conceptual model of care based on three domains: assessment, diagnosis and treatment of illnesses. Individual items within domains correspond to recommended processes of care within national clinical practice guidelines. Summative scores were created to reduce redundancy and enable aggregation across illnesses while maintaining a clear link to clinical domains and our conceptual model. The potential application of the score was explored using data from more than 12 000 children from eight hospitals included in a prior intervention study in Kenya.
  
  
  RESULTS
  Summative scores obtained from items representing discrete clinical decision points reduced redundancy, aided balance of score contribution across domains and enabled direct comparison of disease-specific scores and the calculation of scores for children with comorbidity.
  
  
  CONCLUSIONS
  This work describes the development of a summative Paediatric Admission Quality of Care score measured at the patient level that spans three common diseases. The score may be an efficient tool for assessing quality with an ability to adjust for case mix or other patient-level factors if needed. The score principles may have applicability to multiple illnesses and settings. Future analysis will be needed to validate the score.
authors.affiliation: Health Services Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya. charles.opondo@lshtm.ac.uk.|Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK. charles.opondo@lshtm.ac.uk.
authors.forename: Charles
authors.initials: C
authors.lastname: Opondo
authors.affiliation: Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Allen
authors.affiliation: Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.|Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Jim
authors.initials: J
authors.lastname: Todd
authors.affiliation: Health Services Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya.|Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D002648:Child; D002673:Child, Hospitalized; D015897:Comorbidity; D019983:Guideline Adherence; D006801:Humans; D007630:Kenya; D010372:Pediatrics / Q000592:standards*; D011203:Poverty; D011787:Quality of Health Care
keywords: calidad de los cuidados; directive; guideline; guías; hospital; hôpital; measure; medida; mesure; paediatric; pediátrico; puntuación; pédiatrie; quality of care; qualité des soins; score