Implementation of the WHO standards to assess the quality of care for children with acute diarrhoea: findings of a multicentre study (CHOICE) in Italy.
Humans
Italy
/ epidemiology
Child
Diarrhea
/ therapy
Child, Preschool
Infant
Male
Female
Adolescent
World Health Organization
Acute Disease
Quality of Health Care
/ standards
Emergency Service, Hospital
/ standards
Anti-Bacterial Agents
/ therapeutic use
Hospitalization
/ statistics & numerical data
Probiotics
/ therapeutic use
Qualitative research
Journal
BMJ paediatrics open
ISSN: 2399-9772
Titre abrégé: BMJ Paediatr Open
Pays: England
ID NLM: 101715309
Informations de publication
Date de publication:
30 Aug 2024
30 Aug 2024
Historique:
received:
06
02
2024
accepted:
12
05
2024
medline:
31
8
2024
pubmed:
31
8
2024
entrez:
30
8
2024
Statut:
epublish
Résumé
There is no documented experience in the use of the WHO standards for improving the quality of care (QOC) for children at the facility level. We describe the use of 10 prioritised WHO-Standard-based Quality Measures to assess QOC for children with acute diarrhoea (AD) in Italy. In a multicentre observational study in 11 paediatric emergency departments with different characteristics and geographical location, we collected data on 3061 children aged 6 months to 15 years with AD and no complications. Univariate and multivariate analyses were conducted. Study findings highlighted both good practices and gaps in QoC, with major differences in QOC across facilities. Documentation of body weight and temperature varied from 7.7% to 98.5% and from 50% to 97.7%, respectively (p<0.001); antibiotic and probiotic prescription rates ranged from 0% to 10.1% and from 0% to 80.8%, respectively (p<0.001); hospitalisations rates ranged between 8.5% and 62.8% (p<0.001); written indications for reassessment were provided in 10.4%-90.2% of cases (p<0.001). When corrected for children's individual characteristics, the variable more consistently associated with each analysed outcome was the individual facility. Higher rates of antibiotics prescription (+7.6%, p=0.04) and hospitalisation (+52.9%, p<0.001) were observed for facilities in Southern Italy, compared with university centres (-36%, p<0.001), independently from children characteristics. Children's clinical characteristics in each centre were not associated with either hospitalisation or antibiotic prescription rates. The 10 prioritised WHO-Standard-based Quality Measures allow a rapid assessment of QOC in children with AD. Action is needed to identify and implement sustainable and effective interventions to ensure high QOC for all children.
Sections du résumé
BACKGROUND
BACKGROUND
There is no documented experience in the use of the WHO standards for improving the quality of care (QOC) for children at the facility level. We describe the use of 10 prioritised WHO-Standard-based Quality Measures to assess QOC for children with acute diarrhoea (AD) in Italy.
METHODS
METHODS
In a multicentre observational study in 11 paediatric emergency departments with different characteristics and geographical location, we collected data on 3061 children aged 6 months to 15 years with AD and no complications. Univariate and multivariate analyses were conducted.
RESULTS
RESULTS
Study findings highlighted both good practices and gaps in QoC, with major differences in QOC across facilities. Documentation of body weight and temperature varied from 7.7% to 98.5% and from 50% to 97.7%, respectively (p<0.001); antibiotic and probiotic prescription rates ranged from 0% to 10.1% and from 0% to 80.8%, respectively (p<0.001); hospitalisations rates ranged between 8.5% and 62.8% (p<0.001); written indications for reassessment were provided in 10.4%-90.2% of cases (p<0.001). When corrected for children's individual characteristics, the variable more consistently associated with each analysed outcome was the individual facility. Higher rates of antibiotics prescription (+7.6%, p=0.04) and hospitalisation (+52.9%, p<0.001) were observed for facilities in Southern Italy, compared with university centres (-36%, p<0.001), independently from children characteristics. Children's clinical characteristics in each centre were not associated with either hospitalisation or antibiotic prescription rates.
CONCLUSIONS
CONCLUSIONS
The 10 prioritised WHO-Standard-based Quality Measures allow a rapid assessment of QOC in children with AD. Action is needed to identify and implement sustainable and effective interventions to ensure high QOC for all children.
Identifiants
pubmed: 39214557
pii: 10.1136/bmjpo-2024-002569
doi: 10.1136/bmjpo-2024-002569
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Kevin Valentino
(K)
Chiara Grisaffi
(C)
Fabio Cardinale
(F)
Annunziata Lucarelli
(A)
Lucia Grazia Tricarico
(LG)
Mariateresa De Sario
(M)
Alessandra Pisani
(A)
Maria Carla Finocchiaro
(MC)
Laura Portale
(L)
Francesca Patanè
(F)
Vita Antonella Di Stefano
(VA)
Stefano Masi
(S)
Marco Greco
(M)
Emiliano Talanti
(E)
Andrea Iuorio
(A)
Anna Madera
(A)
Paola Stillo
(P)
Rosa Santangelo
(R)
Nicolò Chiti
(N)
Vanessa Martucci
(V)
Silvia Bloise
(S)
Alessia Marcellino
(A)
Silvia Sordelli
(S)
Maria Luisa Casciana
(ML)
Francesca Tirelli
(F)
Massimo Lo Verde
(ML)
Domenico Cipolla
(D)
Sarah Contorno
(S)
Roberta Parrino
(R)
Giuseppina De Rosa
(G)
Federico Marchetti
(F)
Alessandra Iacono
(A)
Vanna Graziani
(V)
Carlotta Farneti
(C)
Francesco Oppido
(F)
Giulia Sansovini
(G)
Chiara Stefani
(C)
Marcella Massarotto
(M)
Paola Crotti
(P)
Giada Sartor
(G)
Benedetta Ferro
(B)
Riccardo Pavanello
(R)
Marta Minute
(M)
Egidio Barbi
(E)
Ilaria Mariani
(I)
Elia Balestra
(E)
Benmario Castaldo
(B)
Marta Magnolato
(M)
Michele Maiola
(M)
Giorgio Cozzi
(G)
Alessandro Amaddeo
(A)
Alice Del Colle
(AD)
Massimo Dagnelut
(M)
Maristella Toniutti
(M)
Sara Rivellini
(S)
Chiara Pilotto
(C)
Paola Cogo
(P)
Informations de copyright
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.