目的:开发一种适用于中等收入发展中国家的社区获得性肺炎(CAP)患者抗生素管理质量评估工具。
方法:回顾了先前的研究和印度尼西亚指南,以得出潜在的护理质量指标(QI)。专家小组对QI与患者康复的相关性进行了两轮Delphi共识程序,减少抗菌素耐药性和成本控制。在实践中的适用性,包括可靠性,可行性和改进的机会,是在三宝岭128例CAP住院患者的数据集中确定的,印度尼西亚。
结果:通过共识程序选择了15个QI。有5个QI未通过可行性标准,由于不适当的文件,低效的实验室服务或患者因素。三个质量指数提供了微小的改进机会。两个QI相互矛盾;其中一个被认为无效并被排除在外。定义了最后一组六个QI,用于印度尼西亚环境。
结论:使用德尔菲法,我们定义了一个用于评估护理质量的QIs列表,特别是抗生素治疗,在印度尼西亚的CAP。为进一步改进,一种改进的Delphi方法,包括讨论,健全的医疗文件系统,改善微生物实验室服务,和多中心适用性测试需要制定一个有效的和适用的QI列表为印尼设置。
OBJECTIVE: To develop an instrument for evaluating the quality of antibiotic management of patients with community-acquired pneumonia (CAP) applicable in a middle-income developing country.
METHODS: A previous study and Indonesian guidelines were reviewed to derive potential quality of care indicators (QIs). An expert panel performed a two-round Delphi consensus procedure on the QI\'s relevance to patient recovery, reduction of antimicrobial resistance and cost containment. Applicability in practice, including reliability, feasibility and opportunity for improvement, was determined in a data set of 128 patients hospitalised with CAP in Semarang, Indonesia.
RESULTS: Fifteen QIs were selected by the consensus procedure. Five QIs did not pass feasibility criteria, because of inappropriate documentation, inefficient laboratory services or patient factors. Three QIs provided minor opportunity for improvement. Two QIs contradicted each other; one of these was considered not valid and excluded. A final set of six QIs was defined for use in the Indonesian setting.
CONCLUSIONS: Using the Delphi method, we defined a list of QIs for assessing the quality of care, in particular antibiotic treatment, for CAP in Indonesia. For further improvement, a modified Delphi method that includes discussion, a sound medical documentation system, improvement of microbiology laboratory services, and multi-center applicability tests are needed to develop a valid and applicable QI list for the Indonesian setting.