Abstract
ObjectiveDelphi technique is a structured process commonly used to developed healthcare quality indicators, but there is a little recommendation for researchers who wish to use it. This study aimed 1) to describe reporting of the Delphi method to develop quality indicators, 2) to discuss specific methodological skills for quality indicators selection 3) to give guidance about this practice.Methodology and Main FindingThree electronic data bases were searched over a 30 years period (1978–2009). All articles that used the Delphi method to select quality indicators were identified. A standardized data extraction form was developed. Four domains (questionnaire preparation, expert panel, progress of the survey and Delphi results) were assessed. Of 80 included studies, quality of reporting varied significantly between items (9% for year's number of experience of the experts to 98% for the type of Delphi used). Reporting of methodological aspects needed to evaluate the reliability of the survey was insufficient: only 39% (31/80) of studies reported response rates for all rounds, 60% (48/80) that feedback was given between rounds, 77% (62/80) the method used to achieve consensus and 57% (48/80) listed quality indicators selected at the end of the survey. A modified Delphi procedure was used in 49/78 (63%) with a physical meeting of the panel members, usually between Delphi rounds. Median number of panel members was 17(Q1:11; Q3:31). In 40/70 (57%) studies, the panel included multiple stakeholders, who were healthcare professionals in 95% (38/40) of cases. Among 75 studies describing criteria to select quality indicators, 28 (37%) used validity and 17(23%) feasibility.ConclusionThe use and reporting of the Delphi method for quality indicators selection need to be improved. We provide some guidance to the investigators to improve the using and reporting of the method in future surveys.
Highlights
The Institute of Medicine defines healthcare quality as ‘‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and care consistent with current professional knowledge’’ [1]
Improving the quality and safety of healthcare has generated considerable attention in recent years [2]. As part of this thrust, authorities and health care professional used a wide range of methods and tools to promote quality improvement
We identified all reports of studies in which Delphi techniques were used to select quality indicators
Summary
The information required to develop quality indicators can be obtained using systematic or nonsystematic methods Nonsystematic approaches such as case studies are based on data availability and real-time monitoring of critical incidents [5]. Systematic methods enhance decision making [8]; facilitate the development of quality indicators or review criteria for areas where the evidence alone is insufficient [9] or controversy [10],[11]; and synthesize accumulated expert opinion. Among these methods, the Delphi technique has been widely used for quality-indicator development in healthcare
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