GAPS Phase III: incorporation of capacity based weighting in the global assessment for pediatric surgery
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In brief
In brief
This study introduces a capacity-based weighting system for the GAPS tool, which assesses pediatric surgical infrastructure across 64 items in five domains. The enhanced scoring system effectively discriminates hospital and country income levels while correlating with key health indicators, providing a data-driven framework for improving pediatric surgical care in resource-limited settings.
- GAPS tool now uses capacity-based weighting across 5 domains to better assess pediatric surgical capacity in low-resource settings.
- Weighted GAPS scores significantly correlate with hospital level, country income, HDI, and mortality rates (under-5, neonatal, injury).
- The weighting system effectively discriminates between hospital levels (p=0.0001) and country income levels (p=0.002).
- Benchmark scores established for overall and subsection GAPS scores to guide quality improvement in resource-limited centers.
- Enhanced GAPS tool enables data-driven partnerships and strategic interventions for pediatric surgery in LMICs.
Written by the GCMD Library team from the article.
Abstract
Introduction
The Global Assessment for Pediatric Surgery (GAPS) tool was developed to enhance pediatric surgical care in Low- and Middle-Income Countries. This study presents the addition of a capacity-based weighting system to the GAPS tool.
Methods
GAPS, developed through a multi-phase process including systematic review, international testing, item analysis, and refinement, assesses 64 items across 5 domains: human resources, material resources, education, accessibility, and outcomes. This new weighting system differentially weighs each domain. The GAPS Score was evaluated using pilot study data, focusing on hospital and country income levels, human development index, under-five mortality rate, neonatal mortality rate, deaths due to injury and deaths due to congenital anomalies. Analysis involved the Kruskal–Wallis test and linear regression. Benchmark values for the GAPS overall score and subsection scores were identified.
Results
The GAPS score’s capacity-based weighting system effectively discriminated between levels of hospital (p = 0.0001) and country income level (p = 0.002). The GAPS scores showed significant associations with human development index (p < 0.001) and key health indicators such as under-five mortality rates (p < 0.001), neonatal mortality rate (p < 0.001), and deaths due to injury (p < 0.001). Benchmark scores for the GAPS overall score and the subsection scores included most institutions within their respective hospital level.
Conclusions
The GAPS tool and score, enhanced with the capacity-based weighting system, marks progress in assessing pediatric surgical capacity in resource-limited settings. By mirroring the complex reality of hospital functionality in low-resource centers, it provides a refined mechanism for fostering effective partnerships and data-driven strategic interventions.