Entwicklung und Machbarkeitsüberprüfung eines Kern-Sets von Qualitätsindikatoren für die pädiatrische Primärversorgung in Europa - Core Set of Indicators for Paediatric Primary Care in Europe, COSI-PPC-EU

Introduction and background The medical quality in the individual European countries shows considerable differences and deficits [20, 86, 87]. The freedom of movement in the Schengen area leads to further shifts and imbalances through cross-border medicine [70, 61, 6]. The EU admits to every EU citizen to get at least the same medical quality in another European country as in his home country [34]. Studies suggest that qualitative deficits in paediatric primary care in Europe are particularly high, especially because different specialties of medical doctors are involved in the treatment of children and adolescents, and which have different training [32, 50]. Benchmarking tools, such as quality indicators (QI), can promote learning at "best practice" and improve quality and patient safety [45, 54]. QI specifically for paediatric primary care facilities in Europe do not exist - but the EU is calling for them [33]. To close this gap, the "Core Set of Indicators for Paediatric Primary Care in Europe" (COSI-PPC-EU) has been developed [36] and tested for its feasibility [37]. Method The study consists of three subprojects. The first two parts examined whether a valid and feasible QI set for European PPC facilities can be developed and subsequently be consented by a panel of experts. Using a modified RAND/UCLA Appropriateness Method [9] a literature review, a subsequent processing of the QI found, and a multi-stage consensus process were carried out by an international panel. In the third study part European paediatricians were questioned whether these QI were also feasible in their practices. On the basis of their medical records, they determined whether the QI data are available in European practices, how much effort it would take to extract the needed data, whether the QI are applicable to their practices, relevant as well as reliable and can be accepted by them. The practices were specifically selected by country coordinators and should include as many different types as possible. The study was designed as a qualitative exploratory project, with the aim of recruiting 10 participants from 10 countries. Results The first study part revealed through the literature review 1516 QI, which were partially summarized and revised by the expert panel, as well as reduced because of lack of evidence or feasibility down to 50 QI. Of these 50 QI, 42 were finally consented in the second subproject. The QI can be divided into 5 categories: (A) Health promotion, prevention and screening (13 QI), (B) Acute disease (9 QI), (C) Chronic diseases (8 QI), (D) Practice organization (3 QI), (E) Patient safety (9 QI). 79 paediatricians from eight European countries participated in the third study part. It could be shown that the data for the calculation of the QI are mostly available in the sample but the effort for their technical out-reading is time-consuming and the feasibility is limited. Acceptance, relevance and reliability, as well as an application of the QI for their practices, were rated higher, but very different within the individual QI categories. Category (A) showed the highest rates of approval in almost all values. The slight existing, country-specific trends cannot be interpreted reliably due to the specifically selected study participants and the statistically small sample. Discussion and outlook A valid and feasible QI set for European PPC physicians with a broad range of paediatric primary care topics could be compiled in a comprehensive QI-Set, COSI-PPC-EU. The set differs from other QI sets by its targeted orientation towards PPC facilities. Thus it includes, in addition to purely medical indicators, also QI for practice management and patient safety. Consensus among PPC experts and evidence are comparable to other QI sets for PPC, which are however country-specific and not internationally oriented. PPC physicians confirmed in the feasibility study the validity of the COSI-PPC-EU. Technical hurdles still seem to hinder the availability of existing data to calculate the QI and to reduce the feasibility at the present time. If the stakeholders in the health care systems of Europe, and above all the European public health policy makers, have a real interest in a benchmarking process within the PPC, they have to create the political, financial and legal conditions for technical data collection. COSI-PPC-EU can then facilitate a better learning within the European health care systems and improve the quality not only of cross-border medicine for children and adolescents in Europe.