Core Indicator Set for Measuring Quality of Care in Necrotising Enterocolitis: A European Delphi Study

Aim: Inconsistent guidelines and practice variations in necrotising enterocolitis (NEC) hamper care improvements. A universally accepted quality indicator set is needed to standardise and improve care throughout Europe. We aimed to establish a core set relevant to NEC patients and experts. Methods: Clinicians, researchers, and patient representatives evaluated 27 baseline patient characteristics and 41 quality indicators identified by a literature review. Items were rated on a nine-point Likert scale during three online Delphi survey rounds, followed by a consensus meeting. Results: From 19 European countries, 113 participants completed all Delphi rounds, including five patient representatives. All stakeholders reached consensus on eight baseline characteristics. Among the indicators that reached consensus, five of the top 10 were mutually prioritised by patients and experts. In the consensus meeting, attended by two patient representatives and 49 experts from 16 countries, four additional indicators were included. The final core set comprised eight baseline characteristics and nine indicators: one healthcare structure, three care process and five outcome indicators. Conclusion: This study established nine core quality indicators for NEC treatment through consensus among clinicians, researchers, and patient representatives. Their implementation in European clinical audits supports inter-institutional benchmarking, ultimately enhancing care and outcomes for infants with NEC.