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背景儿童保健是英国全科工作的重要组成部分。2009年,在全科问诊患者中,年龄小于15岁的儿童占10.9%。然而,在英国《质量与结果框架》(Quality and Outcomes Framework,QOF)的绩效薪酬激励项目中,仅有1.2%与儿童相关。目的为提高儿童、青少年的医疗质量,制定一套符合循证国家指南并适用于常规计算机临床记录审查的质量指标。设计和场所英国全科多步骤共识法。方法四个步骤:选择重点问题(使用名义群体法)、系统回顾英国国家健康与临床卓越研究所(NICE)与苏格兰校际指南网络(SIGN)临床指南、将指南推荐内容转化为质量指标、评估指标的有效性和实施可行性(利用挑选QOF指标时所用的共识法)。结果在296个已经发布的国家指南中,有48个指南与儿童初级医疗具有潜在相关性,但是在1 863项推荐内容中,仅有123(6.6%)项满足条件,被转化为56项潜在质量指标。通过回顾现有质量指标和标准,另筛选出13项潜在指标。临床专家组针对这69项潜在指标进行李克特量表(Likert scale)评分,得到35项指标,量表满分为9分,中位分数为8分的指标入选。然而,最终仅有7项GRADE评分>1的指标入选(不仅仅基于专家意见)。结论制定有效的儿童初级医疗质量指标是可行的,但是具有难度。尽管这些指标需要在广泛采用之前进行试点测试,但这些指标有望提高儿童初级医疗水平。
Background Child care is an important part of the UK’s general work. In 2009, 10.9% of children less than 15 years of age were in general practice care. However, only 1.2% of the performance pay incentives in the UK’s Quality and Outcomes Framework (QOF) are child-related. Objectives To improve the quality of care of children and adolescents, develop a set of quality indicators that are consistent with evidence-based national guidelines and applicable to routine computer clinical examination. Design and Location UK Multi-Step Consensus. Methods Four steps: selecting the key questions (using the nominal group method), systematically reviewing the clinical guidelines of the National Institute of Health and Clinical Excellence (NICE) and the Scottish Intersection Guidelines (SIGN), converting the recommendations of the guidelines into quality indicators, evaluating The validity of the indicator and the feasibility of its implementation (using the consensus approach used in the selection of the QOF indicator). Results Of the 296 published national guidelines, 48 were potentially relevant for primary care for children, but of the 1 863 recommendations, only 123 (6.6%) met the criteria and were translated into 56 potential Quality Index. By reviewing the existing quality indicators and standards, the other 13 potential indicators were screened out. The clinical expert panel conducted a Likert scale score against these 69 potential indicators and obtained 35 indicators with a full scale of 9 and a median of 8 points. However, in the end, only seven indicators with a GRADE score of> 1 were selected (not just based on expert opinion). Conclusion It is feasible to formulate an effective indicator of primary health care for children, but it is difficult. Although these indicators need to be pilot tested before they are widely adopted, these indicators are expected to improve children’s primary care.