Abstract
BackgroundConsensus methodologies are often used to create evidence-based measures of healthcare quality because they incorporate both available evidence and expert opinion to fill gaps in the knowledge base. However, there are limited studies of the key domains that are considered during panel discussion when developing quality indicators.MethodsWe performed a qualitative content analysis of the discussions from a two-day international workshop of injury control and quality-of-care experts (19 panel members) convened to create a standardized set of quality indicators for injury care. The workshop utilized a modified RAND/UCLA Appropriateness method. Workshop proceedings were recorded and transcribed verbatim. We used constant comparative analysis to analyze the transcripts of the workshop to identify key themes.ResultsWe identified four themes in the selection, development, and implementation of standardized quality indicators: specifying a clear purpose and goal(s) for the indicators to ensure relevant data elements were included, and that indicators could be used for system-wide benchmarking and improving patient outcomes; incorporating evidence, expertise, and patient perspectives to identify important clinical problems and potential measurement challenges; considering context and variations between centers in the health system that could influence either the relevance or application of an indicator; and contemplating data collection and management issues, including availability of existing data sources, quality of data, timeliness of data abstraction, and the potential role for primary data collection.ConclusionOur study provides a description of the key themes of discussion among a panel of clinical, managerial, and data experts developing quality indicators. Consideration of these themes could help shape deliberation of future panels convened to develop quality indicators.
Highlights
Improving the quality of healthcare is a widely recognized international challenge [1,2,3]
The workshop was modeled on the RAND/UCLA Appropriateness Method with the goals of; developing indicators to measure the quality of injury care; prioritizing the indicators; agreeing on an indicator refinement process; establishing an indicator evaluation process; and generating a knowledge translation strategy
Clear purpose and goals of the quality indicators The panelists agreed from the outset that the ultimate goal of using indicators was to improve patient outcomes: ‘. . .I would submit that the end that we seek here is to try and draw the line between the indicator in question and its measurability and whether or not the patients are going to have better outcomes as a consequence.’
Summary
Improving the quality of healthcare is a widely recognized international challenge [1,2,3]. To improve care, the quality of care must first be measured using valid and reliable tools In response to this need, efforts to develop and implement evidence-based measures of quality have increased [4,5]. Quality indicators are one type of quality measure that have been advocated by professional health-provider organizations, institutions, accrediting bodies, and government agencies, e.g., Agency for Healthcare Research and Quality, (AHRQ) [6,7]. These measures compare actual patient care to ideal criteria and can be used by providers, policy makers, and researchers to identify problem areas, tailor interventions, and track subsequent improvements. There are limited studies of the key domains that are considered during panel discussion when developing quality indicators
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