Implementation of the WHO Standards to assess quality of paediatric care at the facility level using service users’ perspective as source of data: a multicentre quality improvement study in Italy

Abstract

ObjectivesThere is little experience in the use of the WHO Standards for improving the quality of care (QOC) for children at the facility level. We describe the use of 75 WHO Standard based Quality Measures to assess paediatric QOC, using service users as a source of data, in Italy.Study designIn a cross-sectional study including 12 hospitals, parents/caregivers of admitted children completed a validated questionnaire including 75 Quality Measures: 40 pertinent to the domain of experience of care; 25 to physical/structural resources; 10 to COVID-19 reorganisational changes. Univariate and multivariate analyses were conducted.ResultsAnswers from 1482 service users were analysed.Physical resourceswas the domain with the higher frequency of reported gaps in QOC, with key gaps (higher rates of responders reporting need for improvement and low variability across centres) being: (1) quality of meals (48.1%; range across facilities: 35.3%–61.7%); (2) presence of cooking areas (50.9%; range: 34.6%–70.0%); (3) spaces for family/friends (51.3%; range: 31.8%–77.4%). Forexperience of care, the most critical gap was the information on the rights of the child (76.6%; range: 59.9%–90.4%), with most other Quality Measures showing an overall frequency of reported need for improvement ranging between 5% and 35%. Forreorganisational changes due to COVID-19an improvement was felt necessary by <25% of responders in all Quality Measures, with low variability across centres. At the multivariate analyses, factors significantly associated with the QOC Index largely varied by QOC domain.ConclusionsThe use of the 75 prioritised Quality Measures, specific to service users’ perspective, enabled the identification of both general and facility-specific gaps in QOC. Based on these findings, quality improvement initiatives shall focus on a core list of selected Quality Measures common to all facilities, plus on an additional list of Quality Measures as more relevant in each facility.