Implementation of the WHO Standards to assess quality of paediatric care at the facility level using service users' perspective as source of data: a multicentre quality improvement study in Italy.

OBJECTIVES: There is little experience in the use of the WHO Standards for improving the quality of care (QOC) for children at the facility level. We describe the use of 75 WHO Standard based Quality Measures to assess paediatric QOC, using service users as a source of data, in Italy. STUDY DESIGN: In a cross-sectional study including 12 hospitals, parents/caregivers of admitted children completed a validated questionnaire including 75 Quality Measures: 40 pertinent to the domain of experience of care; 25 to physical/structural resources; 10 to COVID-19 reorganisational changes. Univariate and multivariate analyses were conducted. RESULTS: Answers from 1482 service users were analysed. Physical resources was the domain with the higher frequency of reported gaps in QOC, with key gaps (higher rates of responders reporting need for improvement and low variability across centres) being: (1) quality of meals (48.1%; range across facilities: 35.3%-61.7%); (2) presence of cooking areas (50.9%; range: 34.6%-70.0%); (3) spaces for family/friends (51.3%; range: 31.8%-77.4%). For experience of care, the most critical gap was the information on the rights of the child (76.6%; range: 59.9%-90.4%), with most other Quality Measures showing an overall frequency of reported need for improvement ranging between 5% and 35%. For reorganisational changes due to COVID-19 an improvement was felt necessary by <25% of responders in all Quality Measures, with low variability across centres. At the multivariate analyses, factors significantly associated with the QOC Index largely varied by QOC domain. CONCLUSIONS: The use of the 75 prioritised Quality Measures, specific to service users' perspective, enabled the identification of both general and facility-specific gaps in QOC. Based on these findings, quality improvement initiatives shall focus on a core list of selected Quality Measures common to all facilities, plus on an additional list of Quality Measures as more relevant in each facility.

Association of juvenile idiopathic arthritis and morphea: a case series.

The association of different autoimmune diseases in the same subject is not uncommon, also in the pediatric age. The coexistence of morphea and juvenile idiopathic arthritis (JIA) is however exceptional. We report four such cases. Unlike the few other reported cases, in 3/4 of our patients, morphea appeared well after the onset of JIA, when the articular disease was in full clinical remission. Based on the epidemiology of pediatric morphea in the general population, this association is unlikely to be fortuitous. Pediatric rheumatologists should be aware of this possible association, and follow clinically patients who achieve long-term clinical remission. Key Points ⦁ Morphea is an unusual occurrence in the context of JIA. These conditions have a common autoimmune background, but are very rarely reported together. ⦁ It is important to follow JIA patients even during long-term remission since other autoimmune phenomena can occur.