Implementation of the WHO Standards to assess the quality of paediatric care using health workers as source of data: Findings of a multicentre study (CHOICE) in Italy

Objectives There is little experience in implementing the WHO Standards for improving the quality of care (QOC) for children. We describe the use of 75 WHO-Standard based Quality Measures to assess paediatric QOC, using health workers (HWs) as data sources. Design Cross-sectional study. Setting 12 Italian hospitals. Participants The minimum target of 75% of HWs was reached in all facilities; answers from 598 HWs were analysed. Primary and secondary outcome measures 75 prioritised WHO Quality Measures were collected using a validated, and Italian-language questionnaire exploring views of HWs providing care to children. A QOC index was also calculated based on the assessed Quality Measures. Results In both the domain of resources and work organisation, most Quality Measures showed a high overall frequency of reported € need for improvement', with high variability across hospitals. Key needs for improvement included: availability of clear and complete protocols (eg, on paediatric emergencies: 44.6%; range 10.6%-92.6%); clear hospitalisation criteria for diarrhoea (50.5%; range 30.3%-71.7%); number of hand-washing stations (13.2%; range 3.4%-37.0%); equipped working rooms with computers for HWs (66.1%; range: 32.1%-97.0%); training (eg, on pain management: 43.5%; range 17.9%-76.7%), periodic discussion of clinical cases (43.5%; range 8.1%-83.7%) audits (48.8%; range 29.7%-76.7%); and all indicators related to system to improve QOC. Factors significantly associated with a lower QOC Index included HWs working in facilities in Southern Italy (p=0.001) and absence of a paediatric emergency department (p=0.011). Conclusions The use of the 75 prioritised Quality Measures, specific to HWs provide valuable data on paediatric QOC, which can be used to drive a quality improvement process.