Development of respiratory disease quality indicators for pediatric patients in Jordanian emergency departments: a RAND/UCLA appropriateness method

Background: Quality indicators (QIs) are important tools for assessing and enhancing healthcare services. The need for valid and feasible quality measurements to gauge improvements and monitor performance is echoed in Jordanian emergency departments (EDs). However, this study aimed to use an evidence-informed expert panel consensus process to identify valid and feasible QIs for pediatric respiratory diseases including asthma, bronchiolitis, and croup in Jordanian EDs. Methods: A modified Research and Development/University of California, Los Angeles (RAND/UCLA) appropriateness method was conducted from February to March 2024 with an expert panel of Jordanian emergency pediatric care. The proposed QIs were derived from a systematic review and categorized according to two frameworks: Donabedian and the Institute of Medicine (IOM). QIs were deemed valid if the median score was ≥7 and feasible if the median score was ≥4, both conditions requiring the absence of significant disagreement. Results: Out of 124 QIs, the expert panel identified 26 (21%) as valid and feasible for specific conditions: asthma, bronchiolitis, and croup. Within the Donabedian, the majority of these QIs were process-oriented (n=23; 88.5%), with a smaller number being outcome-oriented (n=3; 11.5%). None of the indicators pertained to structural elements. While within the IOM, the predominant focus was on indicators related to safety and effectiveness. Additionally, the study identified 25 indicators as valid but not feasible. Conclusions: The findings of this study reveal that a set of indicators are valid for use in the pediatric with asthma, bronchiolitis, and croup care settings of Jordanian EDs. However, the feasibility of most of these QIs depends on the high-quality data availability.