Prioritizing areas for quality marker development in children in UK general practice: extending the use of the nominal group technique.
Gill PJ., Hewitson P., Peile E., Harnden A.
BACKGROUND: There is a deficiency in the ability to measure the quality of care of children in primary care and there is no professional consensus in UK general practice regarding which quality markers should be used. OBJECTIVES: To prioritize clinical areas on which to focus quality marker development in paediatric primary care and to describe the challenges in generating professional consensus. METHODS: We convened an expert panel of GPs with a special interest in child health and using the nominal group technique (NGT), a well-established structured, multistep facilitated group meeting technique, we generated consensus around the key clinical areas to focus quality marker development. RESULTS: Twelve GPs participated in the expert panel. The eight items agreed by panellists as most important were early recognition of serious illness, whole practice involvement in safeguarding, health promotion, mental health, evidence-based management of common conditions, child and carer friendliness and safe and cost-effective prescribing. Panel members struggled to balance the broad clinical areas while attempting to focus on specific areas that are important. The main challenges included managing panel uncertainty, effective organization, presentation of items for review and group inclination to 'include everything'. CONCLUSIONS: This is the first consensus study of UK GPs to identify key areas to target quality marker development in children. By using the NGT, we have highlighted front-line health care professionals' priorities to improve the quality of care of children and identified the benefits and challenges of developing consensus in a broad topic area.