CareTrack Kids—part 1. Assessing the appropriateness of healthcare delivered to Australian children: study protocol for clinical indicator development

Abstract

IntroductionDespite the widespread availability of clinical guidelines, considerable gaps remain between the care that is recommended (appropriate care) and the care provided. This protocol describes a research methodology to develop clinical indicators for appropriate care for common paediatric conditions.Methods and analysisWe will identify conditions amenable to population-level appropriateness of care research and develop clinical indicators for each condition. Candidate conditions have been identified from published research; burden of disease, prevalence and frequency of presentation data; and quality of care priority lists. Clinical indicators will be developed through searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts will review the indicators using a wiki-based approach and modified Delphi process. A formative evaluation of the wiki process will be undertaken.Ethics and disseminationHuman Research Ethics Committee approvals have been received from Sydney Children's Hospital Network, Children's Health Queensland Hospital and Health Service, and the Women's and Children's Health Network (South Australia). Applications are under review with Macquarie University and the Royal Australian College of General Practitioners. We will submit the results of the study to relevant journals and offer national and international presentations.

Parent-reported prevalence and persistence of 19 common child health conditions

“…In the Australian National Health Survey, asthma was the most frequent long-term childhood condition, followed by allergy, refractive vision errors, chronic sinusitis, eczema and mental health issues 1. Overweight/obesity and dental decay are highly prevalent,3–5 while diabetes, epilepsy, attention-deficit hyperactivity disorder (ADHD), anxiety, depression and autism spectrum disorder (ASD) have been identified as key chronic conditions due to their burden 6. Many adolescents are also presenting for headaches and abdominal pain 7.…”

Assessing appropriateness of paediatric asthma management: A population‐based sample survey

“…Recommendations were screened for eligibility and 29 were excluded because: the recommendation was not explicit (e.g. ‘may’ or ‘could’); guiding statements were provided without recommended actions; the likelihood of information being documented was considered low; or they addressed aspects of care deemed out of scope such as ‘structure‐level’ recommendations . The remaining 80 recommendations entered the review process.…”

“…Recommendations were ratified by experts over a two‐stage modified Delphi process, which comprised an email‐based internal review (three rounds) and a collaborative, online, wiki‐based external review (two rounds). Seven experts (six paediatricians and one general practitioner) were recruited for the ‘internal’ ( n = 3) and ‘external’ reviews ( n = 4) . Internal and external reviewers completed their assignments independently to minimize group‐thinking.…”

“…Fifty‐eight indicators were excluded, with 22 passed for external review. External reviewers applied the same scoring criteria as internal reviewers, and also used a nine‐point Likert scale to score each indicator as representative of appropriate care delivered to children during 2012 and 2013 . A total of 21 final recommendations were ratified by external reviewers and these were formatted into 39 medical record audit indicator questions.…”

Non‐indicated acid‐suppression prescribing in a tertiary paediatric hospital: An audit and costing study

“…Internationally, endeavours such as Choosing Wisely seek to measure low‐value, unnecessary care across all ages and specialties . Paediatric low‐value health practices are currently a focus of national initiatives, including the CareTrack Kids study and Royal Australasian College of Physicians' Evolve recommendations . Such initiatives consistently advise that acid‐suppression therapy (AST) is ineffective for treating infants with non‐specific symptoms, like ‘spitting up’ or unsettled behaviour …”