A survey of quality measurement in Canadian sleep centers

Abstract

RATIONALE: Quality indicators have been published for the management of sleep-disordered breathing, but the extent to which quality of care is measured by Canadian sleep centers is unknown. OBJECTIVE The objective of this study is to characterize the measurement of healthcare quality as reported by Canadian sleep centers. METHODS We performed a national online survey of Canadian sleep centers. Surveys were distributed by Canadian respiratory and sleep specialty societies. Respondents reporting formal quality measurement were contacted to complete telephone interviews that characterized the process through which quality was assessed. Questions explored the indicators used, the process by which quality data was collected and reported and barriers and facilitators to effective quality measurement. Quality indicators were categorized based on the aspect of clinical care being evaluated and classified using the Institute of Medicine’s (IOM) quality dimensions (safe, effective, patient-centered, timely, efficient, equitable) and Donabedian’s structure-process-outcome framework. MEASUREMENTS AND MAIN RESULTS: Thirty-four survey responses were received, of which 20 sleep centers reported formal quality measurement. Interviews with 19 of these centers identified 61 indicators that were classified into 11 unique categories. The IOM dimensions of patient-centeredness, effectiveness and timeliness were most common while no centers evaluated equity and only one center measured efficiency. All centers used process measures, while most used outcome measures and only one used a structural quality measure. CONCLUSIONS Among Canadian sleep centers that report formally assessing healthcare quality, measurement was highly variable. These findings highlight the need to identify and mitigate barriers to quality measurement to improve sleep-disordered breathing care.