Developing key performance indicators for a tertiary children's hospital network

Assessing Inequities in Hospital Outcomes for Australian Children From Underserved Populations

OBJECTIVES

Inequity in health outcomes for children and young people (CYP) from underserved populations (Indigenous, culturally and linguistically diverse, refugee and/or asylum seeking, out-of-home care backgrounds, and National Disability Insurance Scheme participants) persists. We quantify baseline inequities in health outcomes to measure the effectiveness of equity interventions.

METHODS

We analyzed electronic medical records on CYP from the Sydney Children's Hospitals Network between 2015 and 2019. The primary outcome measures were high-acuity presentations, potentially preventable hospitalizations (PPH), chronic condition hospitalizations, discharge against medical advice (DAMA), ward and critical care admission, readmission, and extended length of stay (LOS). We used generalized estimating equation models to examine the relationship between underserved population status and outcomes.

RESULTS

One third of 253 934 inpatient and 446 924 emergency department (ED) encounters were underserved CYP. Compared with nonunderserved populations, there was increased risk of PPH (relative risk [RR], 1.25; 95% CI, 1.23-1.27), chronic conditions (RR, 1.09; 95% CI, 1.07-1.10), DAMA (RR, 1.33; 95% CI, 1.19-1.49), ward admission (RR, 1.16; 95% CI, 1.15-1.18), readmission (RR, 1.48; 95% CI, 1.42-1.53), extended inpatient LOS (RR, 1.21; 95% CI, 1.18-1.24), and ED LOS (RR, 1.11; 95% CI, 1.10-1.12). As an example of cumulative risk, Indigenous CYP living with a disability had a 239% higher risk of readmission than CYP without these risk factors (RR, 3.39; 95% CI, 2.92-3.93).

CONCLUSIONS

Interventions are required to reduce health inequities for underserved CYP. We present strategies that include improved patient identification, enhanced service access, and system-wide culture change within an equity learning health system.

Providing Enhanced Access to Child Health Services (PEACH) at Sydney Children's Hospital Network: a study protocol

INTRODUCTION

Children and young people (CYP) from priority populations in Australia have inequities in accessing healthcare, health outcomes and opportunities to lead healthy lives. Priority populations include CYP who are Aboriginal and/or Torres Strait Islander, culturally and linguistically diverse (born in a country where English is not an official language and/or speak a language other than English at home), with experience of being a refugee or asylum seeker, living in out-of-home care or with a disability. Providing Enhanced Access to Child Health Services (PEACH) is an organisation-wide quality improvement project that aims to achieve equivalent health outcomes in CYP from priority populations compared with their non-priority population peers.

METHODS AND ANALYSIS

PEACH creates an equity-focused learning health system using electronic medical record (eMR) patient data and qualitative methodology exploring staff and service user experiences. Five priority population advisory groups, consisting of staff and priority population service users, guide the research at the Sydney Children's Hospitals Network (SCHN), Australia's largest tertiary paediatric health service. Interviews, surveys and co-design workshops with service users (CYP and/or their parent/carer) and staff describe existing health inequities and inform the design and implementation of interventions to improve identification, provision of earlier and supported access to services and effect cultural change. The impact of PEACH on reducing inequity in care and outcomes will be measured by comparing data during and after implementation (2020-2027) with baseline data before implementation (2015-2019) and with national controls, controlling for potential confounding factors. Health access and outcome measures, including emergency and preventable hospitalisations, critical care admission, discharge against medical advice, readmission and extended length of stay, will be analysed and drawn into dashboards, driving continuous learning and improvement.

ETHICS AND DISSEMINATION

The SCHN Human Research Ethics Committee (2022/ETH00145) and Aboriginal Health and Medical Research Council (1920/22) have granted ethics approval. Research findings will be shared with service users, staff advisory groups and the wider children's healthcare sector through presentations, conferences and peer-reviewed journals.

New consensus definition on defining and measuring care for children with paediatric feeding disorder

AIM

This study addresses the absence of a definition of care for children with feeding disorders, limited agreement on key performance indicators (KPIs), and the lack of data linked to those KPIs.

METHODS

Clinicians, consumers and researchers involved in outpatient feeding care in New South Wales (NSW), Australia were invited to participate in a two-Phase study. In Phase 1, a modified Delphi method was used. Two rounds of voting resulted in a new consensus definition of a multidisciplinary paediatric feeding clinic. Three further rounds voting determined relevant KPIs. In Phase 2, the KPIs were piloted prospectively in 10 clinics.

RESULTS

Twenty-six clinicians, consumers and researchers participated in Phase 1. Participation across five voting rounds declined from 92% to 60% and a valid definition and KPI set were created. In Phase 2, the definition and KPIs were piloted in 10 clinics over 6 weeks. Data for 110 patients were collected. The final KPI set of 28 measures proposed covers clinical features, patient demographics and medical issues, parent-child interaction and outcome measures.

CONCLUSIONS

A new definition of a multidisciplinary paediatric feeding clinic is now available, linked to a standardised KPI set covering relevant performance measures. These proved viable in baseline data collection for 10 clinics across NSW. This sets a foundation for further data collection, systematic measurement of care provision and outcomes, and research needed to deliver care improvement for children with paediatric feeding disorder.

Identifying and prioritizing the key performance indicators for hospital management dashboard at a national level: Viewpoint of hospital managers

Participation of main users in identifying key performance indicators (KPIs) for management dashboards contributes to their success. The aim of this study was to identify and prioritize the KPIs of hospital management dashboards from the viewpoint of hospital managers. This study was conducted on managers of public hospitals at a national level in Iran in 2020. Data were collected using a self-administrated questionnaire. The KPIs were classified into five categories, namely financial, operational, human resources, safety and quality of care, services provided to patients. A total of 234 hospital managers participated in this study. Totally, 25 KPIs were determined for the hospital management dashboard, including the patient falls rate, waiting time for patients in the emergency department, patient satisfaction, total hospital revenue, financial balance, bed occupancy rate, patients' discharge with own agreement, average length of stay, and personnel satisfaction. For designing hospital management dashboards, the domains of services provided to patients, safety and quality of care, financial resources, human resources, and operational are important from the hospital managers' viewpoint, respectively. The results of this study can be helpful for developers of business intelligence tools, such as hospital management dashboards, to visualize the most important indicators for managers.

Selecting Performance Indicators and Targets in Health Care: An International Scoping Review and Standardized Process Framework

Objective

Health care organizations monitor hundreds of performance indicators. It is unclear what processes and criteria organizations use to identify the indicators they use, who is involved in these processes, how performance targets are set, and what the impacts of these processes are. The purpose of this study is to synthesize international approaches to indicator selection and develop a standardized process framework.

Methods

Using the PubMed and Web of Science search engines, a scoping review of peer reviewed and grey literature following PRISMA-ScR guidelines was conducted to identify documents describing indicator selection processes used by health systems. English-language papers from 11 countries published from 2010 to 2020 were included. Papers were thematically analyzed to develop a standardized process framework.

Results

The review included 33 peer-reviewed papers and 11 grey-literature documents. While there are common practices used in health care to select indicators, no single standardized process framework for indicator selection exists. Arbitrary or incomplete indicator selection processes risk over-measurement, lack of alignment with strategic and operational goals, lack of support by end-users, and paralyzed decision-making ability. By consolidating international practices, we developed the 5-P indicator selection process framework to mitigate process risks and support high-quality indicator selection processes.

Conclusion

The 5-P indicator selection process framework consists of five domains and 17 elements, and offers health care agencies a practical structure they can use to design indicator selection processes. The framework also provides researchers with a basis by which the implementation of these processes may be evaluated.

Dimensions of performance and related key performance indicators addressed in healthcare organisations: A literature review

INTRODUCTION

Performance measurement systems have become essential managerial tools for healthcare organisations in the last few decades. They allow hospital managers to pilot their institution and assess the development of the organisation in helping managers in decision-making and viewing the different impacts of these decisions. However, there is a need to investigate further the dimensions of performance those performance measurement systems address.

METHODS

A literature review was primarily conduced about performance measures in healthcare organisations. A comparative study was secondly made to identify the different performance dimensions that are present in the literature during the last decade. Forty-nine studies were considered and sixteen proposal frameworks were used to make the comparative analyses.

RESULTS

We classified dimensions depending on the frequency of mobilisation of their components in four categories: the stars, the first runners-up, the opportunists and the forgotten ones. For each of the dimensions presented in this classification, the main types of KPIs proposed in the theoretical frameworks are presented. A discussion on relevance and possible blind spots is then conducted.

CONCLUSION

Although they were a lot of proposal frameworks of KPI proposed in the last decades to assess healthcare organisations, some dimensions remain underrepresented. There is still a need to develop structure KPI and describe their links. To go further, the development of dashboards asks the question of the definition of KPI, the description of their interconnections and their temporality of driving, because static performance reporting systems are not able to completely satisfy healthcare manager's decision support needs.

Identification of Five Quality Needs for Rheumatology (Text Analysis and Literature Review)

Background: While the use of the term "quality" in industry relates to the basic idea of making processes measurable and standardizing processes, medicine focuses on achieving health goals that go far beyond the mere implementation of diagnostic and therapeutic processes. However, the quality management systems used are often simple, self-created concepts that concentrate on administrative processes without considering the quality of the results, which is essential for the patient. For several rheumatic diseases, both outcome and treatment goals have been defined. This work summarizes current mainstreams of strategies with published quality efforts in rheumatology. Methods: PubMed, Cochrane Library, and Web of Science were used to search for studies, and additional manual searches were carried out. Screening and content evaluation were carried out using the PRISMA-P 2015 checklist. After duplicate search in the Endnote reference management software (version X9.1), the software Rayyan QCRI (https://rayyan.qcri.org) was applied to check for pre-defined inclusion and exclusion criteria. Abstracts and full texts were screened and rated using Voyant Tools (https://voyant-tools.org/). Key issues were identified using the collocate analysis. Results: The number of selected publications was small but specific (14 relevant correlations with coefficients >0.8). Using trend analysis, 15 publications with relative frequency of keywords >0.0125 were used for content analysis, revealing 5 quality needs. The treat to target (T2T) initiative was identified as fundamental paradigm. Outcome parameters required for T2T also allow quality assessments in routine clinical work. Quality care by multidisciplinary teams also focusing on polypharmacy and other quality aspects become essential, A global software platform to assess quality aspects is missing. Such an approach requires reporting of multiple outcome parameters according to evidence-based clinical guidelines and recommendations for the different rheumatic diseases. All health aspects defined by the WHO (physical, mental, and social health) have to be integrated into the management of rheumatic patients. Conclusion: For the future, quality projects need goals defined by T2T based initiatives in routine clinical work, secondary quality goals include multidisciplinary cooperation and reduction of polypharmacy. Quality indicators and standards in different health systems will provide new information to optimize patients' care in different health systems.