scholarly journals Development of Quality Indicators for an Integrated Approach of Knee Osteoarthritis

2014 ◽  
Vol 41 (6) ◽  
pp. 1155-1162 ◽  
Author(s):  
Lies Grypdonck ◽  
Bert Aertgeerts ◽  
Frank Luyten ◽  
Hub Wollersheim ◽  
Johan Bellemans ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Usual Care ◽  
Quality Indicators ◽  
Integrated Approach ◽  
High Quality ◽  
Knee Oa ◽  
Process Indicators ◽  
Modified Delphi ◽  
Core Set

Objective.Osteoarthritis (OA) is a common cause of disability worldwide. Knee OA care is often suboptimal. A first necessary step in quality improvement is to gain a clear insight into usual care. We developed a set of evidence-based quality indicators for multidisciplinary high-quality knee OA care.Methods.A Rand-modified Delphi method was used to develop quality indicators for knee OA diagnosis, therapy, and followup. Recommendations were extracted from international guidelines as well as existing sets of quality indicators and scored by a multidisciplinary expert panel. Based on median score, prioritization, and agreement, recommendations were labeled as having a high, uncertain, or low potential to measure quality of care and were discussed in a consensus meeting for inclusion or exclusion. Two final validation rounds yielded a core set of recommendations, which were translated into quality indicators.Results.From a total of 86 recommendations and existing indicators, a core set of 29 recommendations was derived that allowed us to define high-quality knee OA care. From this core set, 22 recommendations were considered to be measurable in clinical practice and were transformed into a final set of 21 quality indicators regarding diagnosis, lifestyle/education/devices, therapy, and followup.Conclusion.Our study provides a robust set of 21 quality indicators for high-quality knee OA care, measurable in clinical practice. These process indicators may be used to measure usual care and evaluate quality improvement interventions across the entire spectrum of disciplines involved in knee OA care.

scholarly journals An Environmental Scan and Evaluation of Home Dialysis Quality Indicators Currently Used in Canada

2020 ◽  
Vol 7 ◽  
pp. 205435812097739
Author(s):  
Lisa Dubrofsky ◽  
Ali Ibrahim ◽  
Karthik Tennankore ◽  
Krishna Poinen ◽  
Sachin Shah ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Peritoneal Dialysis ◽  
Quality Indicators ◽  
Patient Centered ◽  
High Quality ◽  
Home Dialysis ◽  
Environmental Scan ◽  
Starting Point

Background: Quality indicators are important tools to measure and ultimately improve the quality of care provided. Performance measurement may be particularly helpful to grow disciplines that are underutilized and cost-effective, such as home dialysis (peritoneal dialysis and home hemodialysis). Objective: To identify and catalog home dialysis quality indicators currently used in Canada, as well as to evaluate these indicators as a starting point for future collaboration and standardization of quality indicators across Canada. Design: An environmental scan of quality indicators from provincial organizations, quality organizations, and stakeholders. Setting: Sixteen-member pan-Canadian panel with expertise in both nephrology and quality improvement. Patients: Our environmental scan included indicators relevant to patients on home dialysis. Measurements: We classified existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks. Methods: To evaluate the indicators, a 6-person subcommittee conducted a modified version of the Delphi consensus technique based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for further examination. We rated items from 1 to 9 on 6 domains (1-3 does not meet criteria to 7-9 meets criteria) as well as a global final rating (1-3 unnecessary to 7-9 necessary) to distinguish high-quality from low-quality indicators. Results: Overall, we identified 40 quality indicators across 7 provinces, with 22 (55%) rated as “necessary” to distinguish high quality from poor quality care. Ten indicators were measured by more than 1 province, and 5 of these indicators were rated as necessary (home dialysis prevalence, home dialysis incidence, anemia target achievement, rates of peritonitis associated with peritoneal dialysis, and home dialysis attrition). None of these indicators captured the IOM domains of timely, patient-centered, or equitable care. Limitations: The environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals. Conclusions: These results provide Canadian home dialysis programs with a starting point on how to measure quality of care along with the current gaps. This work is an initial and necessary step toward future collaboration and standardization of quality indicators across Canada, so that home dialysis programs can access a smaller number of highly rated balanced indicators to motivate and support patient-centered quality improvement initiatives.

scholarly journals Quality indicators for Palliative Day Services: A modified Delphi study

2018 ◽  
Vol 33 (2) ◽  
pp. 197-205 ◽  
Author(s):  
Noleen K McCorry ◽  
Sean O’Connor ◽  
Kathleen Leemans ◽  
Joanna Coast ◽  
Michael Donnelly ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Indicators ◽  
Delphi Study ◽  
Service Providers ◽  
Panel Discussion ◽  
Unmet Need ◽  
Modified Delphi ◽  
Starting Point ◽  
Day Services

Background: The goal of Palliative Day Services is to provide holistic care that contributes to the quality of life of people with life-threatening illness and their families. Quality indicators provide a means by which to describe, monitor and evaluate the quality of Palliative Day Services provision and act as a starting point for quality improvement. However, currently, there are no published quality indicators for Palliative Day Services. Aim: To develop and provide the first set of quality indicators that describe and evaluate the quality of Palliative Day Services. Design and setting: A modified Delphi technique was used to combine best available research evidence derived from a systematic scoping review with multidisciplinary expert appraisal of the appropriateness and feasibility of candidate indicators. The resulting indicators were compiled into ‘toolkit’ and tested in five UK Palliative Day Service settings. Results: A panel of experts independently reviewed evidence summaries for 182 candidate indicators and provided ratings on appropriateness, followed by a panel discussion and further independent ratings of appropriateness, feasibility and necessity. This exercise resulted in the identification of 30 indicators which were used in practice testing. The final indicator set comprised 7 structural indicators, 21 process indicators and 2 outcome indicators. Conclusion: The indicators fulfil a previously unmet need among Palliative Day Service providers by delivering an appropriate and feasible means to assess, review, and communicate the quality of care, and to identify areas for quality improvement.

scholarly journals On the correlation between outcome indicators and the structure and process indicators used to proxy them in public health care reporting

2021 ◽  
Author(s):  
Benjamin H. Salampessy ◽  
France R. M. Portrait ◽  
Eric van der Hijden ◽  
Ab Klink ◽  
Xander Koolman
Keyword(s):  
Quality Improvement ◽  
Quality Indicators ◽  
Fixed Effects ◽  
Public Health Care ◽  
Internal Quality ◽  
Cross Sectional ◽  
Outcome Indicators ◽  
The Public ◽  
Process Indicators ◽  
Hospital Comparison

AbstractHospital quality indicators provide valuable insights for quality improvement, empower patients to choose providers, and have become a cornerstone of value-based payment. As outcome indicators are cumbersome and expensive to measure, many health systems have relied on proxy indicators, such as structure and process indicators. In this paper, we assess the extent to which publicly reported structure and process indicators are correlated with outcome indicators, to determine if these provide useful signals to inform the public about the outcomes. Quality indicators for three conditions (breast and colorectal cancer, and hip replacement surgery) for Dutch hospitals (2011–2018) were collected. Structure and process indicators were compared to condition-specific outcome indicators and in-hospital mortality ratios in a between-hospital comparison (cross-sectional and between-effects models) and in within-hospital comparison (fixed-effects models). Systematic association could not be observed for any of the models. Both positive and negative signs were observed where negative associations were to be expected. Despite sufficient statistical power, the share of significant correlations was small [mean share: 13.2% (cross-sectional); 26.3% (between-effects); 13.2% (fixed-effects)]. These findings persisted in stratified analyses by type of hospital and in models using a multivariate approach. We conclude that, in the context of compulsory public reporting, structure and process indicators are not correlated with outcome indicators, neither in between-hospital comparisons nor in within-hospital comparisons. While structure and process indicators remain valuable for internal quality improvement, they are unsuitable as signals for informing the public about hospital differences in health outcomes.

Establishment of a Unified Quality Indicators System to Increase the Effectiveness of Emergency Departments

2019 ◽  
Vol 10 (4) ◽  
pp. 1-11
Author(s):  
Anat Ratnovsky ◽  
Shai Rozenes ◽  
Pinchas Halpern
Keyword(s):  
Emergency Department ◽  
Literature Review ◽  
Performance Indicators ◽  
Expert Panel ◽  
High Quality ◽  
Medical Treatments ◽  
Modified Delphi ◽  
Core Set ◽  
Key Indicators

The overall quality of an emergency department (ED) can be measured by its ability to provide fast, efficient yet high-quality medical treatments to its patients. The objective of the present study was to derive a common set of key indicators that could be used to assess the quality of the performance of EDs. A modified Delphi process was employed to achieve this. This consisted of a detailed literature review followed by a three-round expert panel interaction, which was used to reduce and refine the list of indicators. The members of the panel comprised ED physicians, ED nurses and hospital and ED administrators drawn from six EDs. This process yielded 47 essential performance indicators and 12 recommended indicators. The performance indicators were classified into 7 main groups according to their characteristics. The chosen indicators comprise a core set that will be used in an ongoing study on a representative sample of EDs.

scholarly journals An Environmental Scan of Canadian Quality Metrics for Patients on In-Center Hemodialysis

2020 ◽  
Vol 7 ◽  
pp. 205435812097531
Author(s):  
Daniel Blum ◽  
Alison Thomas ◽  
Claire Harris ◽  
Jay Hingwala ◽  
William Beaubien-Souligny ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Quality Indicators ◽  
Quality Metrics ◽  
Care Quality ◽  
Environmental Scan ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Effective Care ◽  
Starting Point

Background: Quality metrics or indicators help guide quality improvement work by reporting on measurable aspects of health care upon which improvement efforts can focus. For recipients of in-center hemodialysis (ICHD) in Canada, it is unclear what ICHD quality indicators exist and whether they adequately cover different domains of health care quality. Objectives: To identify and evaluate current Canadian ICHD quality metrics to document a starting point for future collaborations and standardization of quality improvement in Canada. Design: Environmental scan of quality metrics in ICHD, and subsequent indicator evaluation using a modified Delphi approach. Setting: Canadian ICHD units. Participants: Sixteen-member pan-Canadian working group with expertise in ICHD and quality improvement. Measurements: We classified the existing indicators based on the Institute of Medicine (IOM) and Donabedian frameworks. Methods: Each metric was rated by a 5-person subcommittee using a modified Delphi approach based on the American College of Physicians/Agency for Healthcare Research and Quality criteria. We shared these consensus ratings with the entire 16-member panel for additional comments. Results: We identified 27 metrics that are tracked across 8 provinces, with only 9 (33%) tracked by multiple provinces (ie, more than 1 province). We rated 9 metrics (33%) as “necessary” to distinguish high-quality from low-quality care, of which only 2 were tracked by multiple provinces (proportion of patients by primary access and rate of vascular access-related bloodstream infections). Most (16/27, 59%) indicators assessed the IOM domains of safe or effective care, and none of the “necessary” indicators measured the IOM domains of timely, patient-centered, or equitable care. Limitations: The environmental scan is a nonexhaustive list of quality indicators in Canada. The panel also lacked representation from patients, administrators, and allied health professionals, with more representation from academic sites. Conclusions: Quality indicators in Canada mainly focus on safe and effective care, with little provincial overlap. These results highlight current gaps in quality of care measurement for ICHD, and this initial work should provide programs with a starting point to combine highly rated indicators with newly developed indicators into a concise balanced scorecard that supports quality improvement initiatives across all aspects of ICHD care. Trial Registration: not applicable.

scholarly journals A Concise Set of Structure and Process Indicators to Assess and Compare Antimicrobial Stewardship Programs Among EU and US Hospitals: Results From a Multinational Expert Panel

2016 ◽  
Vol 37 (10) ◽  
pp. 1201-1211 ◽  
Author(s):  
Lori A. Pollack ◽  
Diamantis Plachouras ◽  
Ronda Sinkowitz-Cochran ◽  
Heidi Gruhler ◽  
Dominique L. Monnet ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Importance ◽  
The United States ◽  
Future Studies ◽  
Eu Member States ◽  
Process Indicators ◽  
Modified Delphi ◽  
Stewardship Program ◽  
Core Set ◽  
Special Studies

OBJECTIVESTo develop common indicators, relevant to both EU member states and the United States, that characterize and allow for meaningful comparison of antimicrobial stewardship programs among different countries and healthcare systems.DESIGNModified Delphi process.PARTICIPANTSA multinational panel of 20 experts in antimicrobial stewardship.METHODSPotential indicators were rated on the perceived feasibility to implement and measure each indicator and clinical importance for optimizing appropriate antimicrobial prescribing.RESULTSThe outcome was a set of 33 indicators developed to characterize the infrastructure and activities of hospital antimicrobial stewardship programs. Among them 17 indicators were considered essential to characterize an antimicrobial stewardship program and therefore were included in a core set of indicators. The remaining 16 indicators were considered optional indicators and included in a supplemental set.CONCLUSIONSThe integration of these indicators in public health surveillance and special studies will lead to a better understanding of best practices in antimicrobial stewardship. Additionally, future studies can explore the association of hospital antimicrobial stewardship programs to antimicrobial use and resistance.Infect Control Hosp Epidemiol 2016:1–11

scholarly journals Updating quality indicators for low-risk labour care in Japan using current clinical practice guidelines: a modified Delphi method

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023595 ◽  
Author(s):  
Kayo Ueda ◽  
Misato Kaso ◽  
Shosuke Ohtera ◽  
Takeo Nakayama
Keyword(s):  
Clinical Practice ◽  
Quality Indicators ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Delphi Method ◽  
Low Risk ◽  
Potential Candidate ◽  
Modified Delphi Method ◽  
Modified Delphi ◽  
Definition Of

ObjectivesQuality indicators are measurable elements widely used to assess the quality of care. They are often developed from the results of systematic reviews or clinical practice guidelines. These sources are regularly updated in line with new clinical evidence, but there are few articles on updating quality indicators based on clinical practice guidelines. This study aimed to update the quality indicators developed for low-risk labour care in Japan in 2012, mainly drawing on new or updated clinical practice guidelines, and making the process clearly visible and assessable.Design and settingWe used a modified Delphi method for the update. The procedure included four steps: (1) updating the definition of low-risk labour; (2) reviewing the literature published between June 2012 and December 2015 using five guidelines and two quality indicator databases to extract potential candidate indicators; (3) formation of a multidisciplinary panel including mothers and (4) panel ratings (two rounds between February and April 2016) on the validity of the candidate indicators, and judging the validity of the previous quality indicators drawing on the new evidence.ParticipantsA multidisciplinary panel of 13 clinicians, including obstetricians, paediatricians and midwives, plus 3 non-clinician mothers.ResultsThe literature review identified 276 new recommendations from 27 clinical practice guidelines including 2 published in Japan and 21 quality indicators. We developed 13 new candidate indicators from these sources and panel recommendations, 12 of which were approved by the multidisciplinary panel. The panel also accepted all 23 existing quality indicators as still valid, resulting in a total of 35 quality indicators for low-risk labour.ConclusionsWe successfully updated the quality indicators for low-risk labour care in Japan. The procedure developed may be useful for updating other quality indicators based on new clinical practice guidelines.

scholarly journals Screening for important unwarranted variation in clinical practice: a triple-test of processes of care, costs and patient outcomes

2017 ◽  
Vol 41 (1) ◽  
pp. 104 ◽  
Author(s):  
Andrew Partington ◽  
Derek P. Chew ◽  
David Ben-Tovim ◽  
Matthew Horsfall ◽  
Paul Hakendorf ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Comparative Analysis ◽  
Improve Quality ◽  
Processes Of Care ◽  
Process Indicators ◽  
Potential Value ◽  
Triple Test ◽  
Unwarranted Variation ◽  
Care Costs

Objective Unwarranted variation in clinical practice is a target for quality improvement in health care, but there is no consensus on how to identify such variation or to assess the potential value of initiatives to improve quality in these areas. This study illustrates the use of a triple test, namely the comparative analysis of processes of care, costs and outcomes, to identify and assess the burden of unwarranted variation in clinical practice. Methods Routinely collected hospital and mortality data were linked for patients presenting with symptoms suggestive of acute coronary syndromes at the emergency departments of four public hospitals in South Australia. Multiple regression models analysed variation in re-admissions and mortality at 30 days and 12 months, patient costs and multiple process indicators. Results After casemix adjustment, an outlier hospital with statistically significantly poorer outcomes and higher costs was identified. Key process indicators included admission patterns, use of invasive diagnostic procedures and length of stay. Performance varied according to patients’ presenting characteristics and time of presentation. Conclusions The joint analysis of processes, outcomes and costs as alternative measures of performance inform the importance of reducing variation in clinical practice, as well as identifying specific targets for quality improvement along clinical pathways. Such analyses could be undertaken across a wide range of clinical areas to inform the potential value and prioritisation of quality improvement initiatives. What is known about the topic? Variation in clinical practice is a long-standing issue that has been analysed from many different perspectives. It is neither possible nor desirable to address all forms of variation in clinical practice: the focus should be on identifying important unwarranted variation to inform actions to reduce variation and improve quality. What does this paper add? This paper proposes the comparative analysis of processes of care, costs and outcomes for patients with similar diagnoses presenting at alternative hospitals, using linked, routinely collected data. This triple test of performance indicators extracts maximum value from routine data to identify priority areas for quality improvement to reduce important and unwarranted variations in clinical practice. What are the implications for practitioners? The proposed analyses need to be applied to other clinical areas to demonstrate the general application of the methods. The outputs can then be validated through the application of quality improvement initiatives in clinical areas with identified important and unwarranted variation. Validated frameworks for the comparative analysis of clinical practice provide an efficient approach to valuing and prioritising actions to improve health service quality.

scholarly journals Canadian Association of Gastroenterology Consensus Guidelines on Safety and Quality Indicators in Endoscopy

2012 ◽  
Vol 26 (1) ◽  
pp. 17-31 ◽  
Author(s):  
David Armstrong ◽  
Alan Barkun ◽  
Ron Bridges ◽  
Rose Carter ◽  
Chris de Gara ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Service Delivery ◽  
Quality Indicators ◽  
Gastrointestinal Endoscopy ◽  
Patient Perceptions ◽  
Quality And Safety ◽  
Consensus Guidelines ◽  
High Quality ◽  
Web Based ◽  
Delphi Approach

Several organizations worldwide have developed procedure-based guidelines and/or position statements regarding various aspects of quality and safety indicators, and credentialing for endoscopy. Although important, they do not specifically address patient needs or provide a framework for their adoption in the context of endoscopy services. The consensus guidelines reported in this article, however, aimed to identify processes and indicators relevant to the provision of high-quality endoscopy services that will support ongoing quality improvement across many jurisdictions, specifically in the areas of ethics, facility standards and policies, quality assurance, training and education, reporting standards and patient perceptions.BACKGROUND: Increasing use of gastrointestinal endoscopy, particularly for colorectal cancer screening, and increasing emphasis on health care quality, highlight the need for clearly defined, evidence-based processes to support quality improvement in endoscopy.OBJECTIVE: To identify processes and indicators of quality and safety relevant to high-quality endoscopy service delivery.METHODS: A multidisciplinary group of 35 voting participants developed recommendation statements and performance indicators. Systematic literature searches generated 50 initial statements that were revised iteratively following a modified Delphi approach using a web-based evaluation and voting tool. Statement development and evidence evaluation followed the AGREE (Appraisal of Guidelines, REsearch and Evaluation) and GRADE (Grading of Recommendations, Assessment, Development and Evaluation) guidelines. At the consensus conference, participants voted anonymously on all statements using a 6-point scale. Subsequent web-based voting evaluated recommendations for specific, individual quality indicators, safety indicators and mandatory endoscopy reporting fields. Consensus was defined a priori as agreement by 80% of participants.RESULTS: Consensus was reached on 23 recommendation statements addressing the following: ethics (statement 1: agreement 100%), facility standards and policies (statements 2 to 9: 90% to 100%), qual: 97% to 100%) and patient perceptions ( statements 22 and 23: 100%). Additionally, 18 quality indicators (agreement 83% to 100%), 20 safety indicators (agreement 77% to 100%) and 23 recommended endoscopy-reporting elements (agreement 91% to 100%) were identified.DISCUSSION: The consensus process identified a clear need for high-quality clinical and outcomes research to support quality improvement in the delivery of endoscopy services.CONCLUSIONS: The guidelines support quality improvement in endoscopy by providing explicit recommendations on systematic monitoring, assessment and modification of endoscopy service delivery to yield benefits for all patients affected by the practice of gastrointestinal endoscopy.

Sign in / Sign up

Export Citation Format

Share Document