• Helmia Farida, Angelique Rondags, M Hussein Gasem, Katharina Leong, A Adityana, Peterhans J van den Broek, Monique Keuter, and Stephanie Natsch.
• Department of Microbiology, Faculty of Medicine, Diponegoro University and Dr. Kariadi Hospital, Semarang, Indonesia.
• Trop. Med. Int. Health. 2015 Apr 1;20(4):501-9.

ObjectiveTo develop an instrument for evaluating the quality of antibiotic management of patients with community-acquired pneumonia (CAP) applicable in a middle-income developing country.MethodA previous study and Indonesian guidelines were reviewed to derive potential quality of care indicators (QIs). An expert panel performed a two-round Delphi consensus procedure on the QI's relevance to patient recovery, reduction of antimicrobial resistance and cost containment. Applicability in practice, including reliability, feasibility and opportunity for improvement, was determined in a data set of 128 patients hospitalised with CAP in Semarang, Indonesia.ResultsFifteen QIs were selected by the consensus procedure. Five QIs did not pass feasibility criteria, because of inappropriate documentation, inefficient laboratory services or patient factors. Three QIs provided minor opportunity for improvement. Two QIs contradicted each other; one of these was considered not valid and excluded. A final set of six QIs was defined for use in the Indonesian setting.ConclusionUsing the Delphi method, we defined a list of QIs for assessing the quality of care, in particular antibiotic treatment, for CAP in Indonesia. For further improvement, a modified Delphi method that includes discussion, a sound medical documentation system, improvement of microbiology laboratory services, and multi-center applicability tests are needed to develop a valid and applicable QI list for the Indonesian setting.© 2014 John Wiley & Sons Ltd.

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