運用修正型德菲法與健保資料庫開發具可行性的兒科品質報告卡指標

The use of modified Delphi method and health insurance database to develop feasible indicators for pediatric quality report card

目標：訂出適合我國國情並能與國外接軌的兒科品質報告卡指標。方法：參考國際組織與國外文獻發展的兒科指標，並邀請兒科及家醫科等相關的專家，以按照重要性、效度及改善機會等準則來萃取出專家偏好的指標，最後再陸續以不同的方法（如專家會議、修正型德菲法及健保資料庫輔助）來產生最終的代表性指標。結果：本研究選擇了4項兒科領域（3項疾病領域）：氣喘、積液性中耳炎、尿道感染及一般結果（例如死亡率）等，此4項領域共辨識出49項相關候選指標，最後選出7項兒科品質報告卡代表指標，包括氣喘4項，積液性中耳炎1項，以及尿道感染2項，這7項品質報告卡代表性指標的比率大部分呈現逐年惡化的品質趨勢。結論：本研究以修正型德菲法選出7項適合我國國情以及與國際接軌的指標，政府單位可參考本研究成果發展兒科品質報告卡來改善品質。

Objectives: To develop pediatric indicators of public report card that are suitable for Taiwan’s context and aligned with international standards. Methods: We referenced the pediatric indicators developed by international organizations and the literature and invited experts with specialties in pediatric and family medicine in order to extract their preferred indicators according to the selection criteria of importance, validity, and feasibility. The final results of the representative indicators were subsequently produced through different methods (i.e. professional meetings, modified Delphi, and aid from the National Health Insurance Administration (NHIA)’s claims database). Results: We chose four pediatric disease fields: asthma, otitis media with effusion (OME), urine tract infection (UTI), and general outcomes (e.g. mortality). We next identified a total of 49 candidate indicators from these 4 fields (3 disease categories) and then finally selected 7 representative indicators for the pediatric quality report card, including 4 asthma-related indicators, 1 OME indicator, and 2 UTI indicators. The adherence rates for most of these indicators demonstrated steadily deteriorating trends of quality. Conclusions: We employed the modified Delphi method to elicit 7 representative indicators that are suitable for our context and aligned with international standards. The government can utilize our study’s results to develop a pediatric quality report card for improving quality of pediatric care.