Publication: Development and validation of quality indicators for pediatric respiratory care in emergency departments in Jordan
| dc.contributor.author | Alkhazali, Islam Emad Ahmad | |
| dc.date.accessioned | 2026-04-26T07:07:50Z | |
| dc.date.available | 2026-04-26T07:07:50Z | |
| dc.date.issued | 2025-11 | |
| dc.description.abstract | Pediatric respiratory diseases, particularly asthma, bronchiolitis, and croup, remain among the leading causes of emergency department (ED) visits worldwide. These acute conditions place a considerable burden on emergency services, requiring timely, evidence-based interventions to ensure high-quality care. Quality measurement is essential for both assurance and continuous improvement in healthcare and begins with the development of quality indicators (QIs) against which clinical performance can be assessed. However, no published studies have developed or adapted QIs specifically tailored to pediatric respiratory care within the context of Jordanian EDs. This study aimed to develop and validate QIs for pediatric respiratory diseases in Jordanian EDs and was conducted in three interrelated phases to ensure a systematic and evidence-based process. In Phase I, a systematic review and meta-analysis identified existing international QIs for asthma, bronchiolitis, and croup. A total of 255 QIs were extracted from 26 studies. The included studies demonstrated variable risk of bias, and compliance with the identified QIs differed considerably across healthcare sectors. In Phase II, candidate QIs were evaluated using the RAND/UCLA Appropriateness Method, a structured consensus technique integrating scientific evidence with expert judgment to assess validity and feasibility. Two rounds of expert panel review resulted in 26 QIs rated as both valid and feasible. In parallel, qualitative interviews with 13 experts explored the barriers and facilitators to QI implementation. Thematic analysis revealed four barrier themes (e.g., human resources, infrastructure) and five facilitator themes (e.g., electronic systems, administrative support). Phase III employed a mixed methods design in two EDs to evaluate the feasibility and compliance of 26 QIs through prospective observations of asthma (n = 249), bronchiolitis (n = 91), and croup (n = 147) cases, alongside retrospective chart audits. All QIs were feasible via direct observation; however, 10 (38%) were not feasible through chart audits due to incomplete documentation. Compliance analysis showed that 52% (12 QIs) achieved high compliance, although overuse of radiography and antibiotics persisted. The qualitative component of this phase identified two key dimensions, factors influencing QI compliance and documentation practices, resulting in eight themes and seventeen subthemes, including patient condition, ED environment, and social pressure. Overall, this study produced a valid, feasible, and contextually relevant set of QIs tailored for Jordanian EDs, offering a practical tool to assess and enhance the quality of pediatric respiratory care. | |
| dc.identifier.uri | https://erepo.usm.my/handle/123456789/23999 | |
| dc.language.iso | en | |
| dc.title | Development and validation of quality indicators for pediatric respiratory care in emergency departments in Jordan | |
| dc.type | Resource Types::text::thesis::doctoral thesis | |
| dspace.entity.type | Publication | |
| oairecerif.author.affiliation | Universiti Sains Malaysia |