AUTHOR=Waibel Sina , Wu Wan Ling , Smith Michael , Johnson L. Kit , Janke Rita D. 

TITLE=Selection of Pediatric Mental Health Quality Measures for Health System Improvement in British Columbia Based on a Modified Delphi Approach

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.866391

DOI=10.3389/fped.2022.866391

ISSN=2296-2360

ABSTRACT=Background: The COVID-19 pandemic has highlighted the importance of mental well-being. The identification and implementation of quality measures can improve health outcomes and patient experience. The objective was to identify and define a core set of valid and relevant pediatric mental health quality measures that will support health system evaluation and quality improvement in British Columbia, Canada.
Methods: The study consisted of four phases. First, a comprehensive database search identified valid pediatric quality measures focused on mental health including substance use (MH/SU). Second, focus areas were prioritized by an expert panel and quality measures were mapped to the focus areas. Third, two representative measures for each focus area were pre-selected. And fourth, a three-step modified Delphi approach was employed to (1) assess each quality measure on a 7-point Likert scale against three relevance criteria (representative of a quality problem, value to intended audience and actionable), (2) discuss the results, and (3) select and rank the most relevant measures. For round 1, consensus was determined when at least 70% of the response rates were within the range of five to seven. For round 3, Kendall's coefficient of concordance W was used as an estimator of interrater reliability.
Results: Over 100 pediatric mental health quality measures were identified in the database search. Of those, 37 were mapped to ten focus areas. Pre-selection resulted in 19 representative measures moving forward to the Delphi study. Eleven measures met the consensus thresholds and were brought forward to the round 2 discussion. Round 3 ranking showed moderate to strong raters’ agreement (Kendall’s W=0.595; p<0.01) and resulted in the following five highest-ranked measures: level of satisfaction after discharge from inpatient admission due to MH/SU, number of patients experiencing seclusion or restraint, length of time from eating disorder referral to assessment, number of ED visits due to MH/SU, and number of readmissions to ED after self-harm.
Conclusion:  The selected core set of valid and relevant pediatric quality measures will support sustainable system change in British Columbia. The five top-ranked measures will be refined and tested for data collection feasibility before being implemented in the province.