title: Development of Quality Metrics to Evaluate Pediatric Hematologic Oncology Care in the Outpatient Setting.
abstract: There are currently no clinic-level quality of care metrics for outpatient pediatric oncology. We sought to develop a list of quality of care metrics for a leukemia-lymphoma (LL) clinic using a consensus process that can be adapted to other clinic settings. Medline-Ovid was searched for quality indicators relevant to pediatric oncology. A provisional list of 27 metrics spanning 7 categories was generated and circulated to a Consensus Group (CG) of LL clinic medical and nursing staff. A Delphi process comprising 2 rounds of ranking generated consensus on a final list of metrics. Consensus was defined as ≥70% of CG members ranking a metric within 2 consecutive scores. In round 1, 19 of 27 (70%) metrics reached consensus. CG members' comments resulted in 4 new metrics and revision of 8 original metrics. All 31 metrics were included in round 2. Twenty-four of 31 (77%) metrics reached consensus after round 2. Thirteen were chosen for the final list based on highest scores and eliminating redundancy. These included: patient communication/education; pain management; delay in access to clinical psychology, documentation of chemotherapy, of diagnosis/extent of disease, of treatment plan and of follow-up scheme; referral to transplant; radiation exposure during follow-up; delay until chemotherapy; clinic cancellations; and school attendance. This study provides a model of quality metric development that other clinics may use for local use. The final metrics will be used for ongoing quality improvement in the LL clinic.
authors.affiliation: *Undergraduate Medical Education, Faculty of Medicine, University of Toronto †Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Teichman
authors.forename: Angela
authors.initials: A
authors.lastname: Punnett
authors.forename: Sumit
authors.initials: S
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D032921:Consensus; D003697:Delphi Technique; D006402:Hematologic Diseases / Q000628:therapy; D006405:Hematology / Q000592:standards*; D006801:Humans; D007223:Infant; D008495:Medical Oncology / Q000592:standards*; D009369:Neoplasms / Q000628:therapy; D009864:Ontario; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D010372:Pediatrics / Q000592:standards*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D062606:Tertiary Care Centers