Evaluation of the WHO standards to assess quality of care for children with acute respiratory infections: findings of a baseline multicentre assessment (CHOICE) in Italy
Findings on the 10 prioritised WHO standard-bases quality measures on paediatric ARI. Hospitalization (any) = both hospitalisation and short duration of stay. HR, heart rate; RR, respiratory rate; T°, body temperature (Celsius). SpO2%, oxygen saturation. Ind, indication. 1For C11, only 2019 data were available.Abstract
ABSTRACT
Background Experience is lacking on the implementation of the WHO standards for improving the quality of care (QOC) for children at facility level. We describe the use of 10 prioritised WHO standard-based quality measures to assess provision of care for children with acute respiratory infections (ARI) in Italy. Methods In a multicentre observational study across 11 emergency departments with different characteristics, we collected 10 WHO standard-based quality measures related to case management of children with ARI and no emergency/priority signs. Univariate and multivariate analyses were conducted. Results Data from 3145 children were collected. Major differences in QOC across facilities were observed: documentation of saturation level and respiratory rate varied from 34.3% to 100% and from 10.7% to 62.7%, respectively (p<0.001); antibiotic prescription rates ranged from 22.6% to 80.0% (p<0.001), with significant differences in the pattern of prescribed antibiotic; hospitalisations rates ranged between 2.3% and 30.6% (p<0.001). When corrected for children’s individual sociodemographic and clinical characteristics, the variable more consistently associated with each analysed outcome was the individual facility where the child was managed. Higher rates of antibiotics prescription (+33.1%, p<0.001) and hospitalisation (+24.7%,p<0.001) were observed for facilities in Southern Italy, while university centres were associated with lower hospitalisation rates (−13.1%, p<0.001), independently from children’s characteristics. Conclusions The use of 10 WHO standard-based measures can help quickly assess QOC for children with ARI. There is an urgent need to invest more in implementation research to identify sustainable and effective interventions to ensure that all children receive high QOC.
Paolo Dalena
Data Scientist
Health Researcher
PhD Candidate in Artificial Intelligence & Applied Data Science
Data Scientist, R-enthusiast, building my future.