BACKGROUND Variable and poor care quality are important causes of preventable patient harm. Many patients receive less than recommended care, but the extent of the problem remains largely unknown. The CareTrack Kids (CTK) research programme sought to address this evidence gap by developing a set of indicators to measure the quality of care for common paediatric conditions. In this study, we focus on one clinical area, 'preventive care' for pre-school aged children. Our objectives were two-fold: (i) develop and validate preventive care quality indicators and (ii) apply them in general medical practice to measure adherence. METHODS Clinical experts (n = 6) developed indicator questions (IQs) from clinical practice guideline (CPG) recommendations using a multi-stage modified Delphi process, which were pilot tested in general practice. The medical records of Australian children (n = 976) from general practices (n = 80) in Queensland, New South Wales and South Australia identified as having a consultation for one of 17 CTK conditions of interest were retrospectively reviewed by trained paediatric nurses. Statistical analyses were performed to estimate percentage compliance and its 95% confidence intervals. RESULTS IQs (n = 43) and eight care 'bundles' were developed and validated. Care was delivered in line with the IQs in 43.3% of eligible healthcare encounters (95% CI 30.5-56.7). The bundles of care with the highest compliance were 'immunisation' (80.1%, 95% CI 65.7-90.4), 'anthropometric measurements' (52.7%, 95% CI 35.6-69.4) and 'nutrition assessments' (38.5%, 95% CI 24.3-54.3), and lowest for 'visual assessment' (17.9%, 95% CI 8.2-31.9), 'musculoskeletal examinations' (24.4%, 95% CI 13.1-39.1) and 'cardiovascular examinations' (30.9%, 95% CI 12.3-55.5). CONCLUSIONS This study is the first known attempt to develop specific preventive care quality indicators and measure their delivery to Australian children in general practice. Our findings that preventive care is not reliably delivered to all Australian children and that there is substantial variation in adherence with the IQs provide a starting point for clinicians, researchers and policy makers when considering how the gap between recommended and actual care may be narrowed. The findings may also help inform the development of specific improvement interventions, incentives and national standards.

中文翻译：

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澳大利亚一般实践中对学龄前儿童的预防保健质量。

背景技术可变和差的护理质量是可预防的患者伤害的重要原因。许多患者得到的护理少于推荐的护理，但是问题的严重程度仍然未知。CareTrack Kids（CTK）研究计划试图通过开发一套指标来衡量常见儿科疾病的护理质量，以弥补这一证据差距。在这项研究中，我们集中于一个临床领域，即学龄前儿童的“预防保健”。我们的目标有两个：（i）制定和验证预防保健质量指标，以及（ii）将其应用于一般医学实践中以衡量依从性。方法临床专家（n = 6）使用多阶段改进的Delphi流程，根据临床实践指南（CPG）的建议制定了指标问题（IQ），并在一般实践中进行了先导测试。由昆士兰州，新南威尔士州和南澳大利亚州的普通儿童（n = 80）中的澳大利亚儿童（n = 976）的病历经培训的儿科护士进行了回顾性审查，这些患者被确认对17种CTK相关疾病之一进行了咨询。进行统计分析以估计顺应性百分比及其95％的置信区间。结果智商（n = 43）和八个护理“捆绑”被开发和验证。在符合条件的医护人员中，有43.3％的护理符合智商（95％CI 30.5-56.7）。依从性最高的护理包是“免疫”（80.1％，95％CI 65.7-90.4），“人体测量”（52.7％，95％CI 35.6-69.4）和“营养评估”（38.5％，95％） CI 24.3-54.3），“视觉评估”最低（17.9％，CI为95％8）。2-31.9），“肌肉骨骼检查”（24.4％，95％CI 13.1-39.1）和“心血管检查”（30.9％，95％CI 12.3-55.5）。结论这项研究是开发特定预防保健质量指标并衡量其在一般实践中对澳大利亚儿童的分娩的首次已知尝试。我们的发现表明，预防性护理不能可靠地提供给所有澳大利亚儿童，并且对智商的依从性存在很大差异，这为临床医生，研究人员和政策制定者在考虑如何缩小推荐与实际护理之间的差距时提供了一个起点。这些发现也可能有助于为具体的改进措施，激励措施和国家标准的制定提供信息。（30.9％，95％CI 12.3-55.5）。结论这项研究是开发特定预防保健质量指标并衡量其在一般实践中对澳大利亚儿童的分娩的首次已知尝试。我们的发现表明，预防性护理不能可靠地提供给所有澳大利亚儿童，并且对智商的依从性存在很大差异，这为临床医生，研究人员和政策制定者在考虑如何缩小推荐与实际护理之间的差距时提供了一个起点。这些发现也可能有助于为具体的改进措施，激励措施和国家标准的制定提供信息。（30.9％，95％CI 12.3-55.5）。结论这项研究是开发特定预防保健质量指标并衡量其在一般实践中对澳大利亚儿童的分娩的首次已知尝试。我们的发现表明，预防性护理不能可靠地提供给所有澳大利亚儿童，并且对智商的依从性存在很大差异，这为临床医生，研究人员和政策制定者在考虑如何缩小推荐与实际护理之间的差距时提供了一个起点。这些发现也可能有助于为具体的改进措施，激励措施和国家标准的制定提供信息。我们的发现表明，预防性护理不能可靠地提供给所有澳大利亚儿童，并且对智商的依从性存在很大差异，这为临床医生，研究人员和政策制定者在考虑如何缩小推荐与实际护理之间的差距时提供了一个起点。这些发现也可能有助于为具体的改进措施，激励措施和国家标准的制定提供信息。我们的发现表明，预防性护理不能可靠地提供给所有澳大利亚儿童，并且对智商的依从性存在很大差异，这为临床医生，研究人员和政策制定者在考虑如何缩小推荐与实际护理之间的差距时提供了一个起点。这些发现也可能有助于为具体的改进措施，激励措施和国家标准的制定提供信息。