Candidate Quality Indicators Research Articles

Hospital Quality Indicators for Opioid-Exposed Infants: Results From an Expert Consensus Panel.

To elicit expert consensus on quality indicators for the hospital-based care of opioid-exposed infants. We used the ExpertLens online platform to conduct a 3-round modified Delphi panel. Expert panelists included health care providers, parents in recovery, quality experts, and public health experts. We identified 49 candidate quality indicators from a literature review and environmental scan. A total of 32 experts rated the importance and feasibility of the indicators using a 9-point Likert scale (Round 1), reviewed and discussed the initial ratings (round 2), and revised their original ratings (Round 3). Numeric scores corresponded with descriptive ratings of "low" (1-3), "uncertain" (4-6), or "high" (7-9). We measured consensus using the RAND/UCLA Appropriateness Method. Candidate quality indicators assessed structures, processes, and outcomes in multiple domains of clinical care. After the final round, 36 indicators were rated "high" on importance and feasibility. Experts had strong consensus on the importance of quality indicators to assess universal screening of pregnant people for substance use disorder, hospital staff training, standardized assessment for neonatal opioid withdrawal syndrome, nonpharmacologic interventions, and transitions of care. For indicators focused on processes and outcomes, experts saw feasibility as dependent on the information routinely documented in electronic medical records or billing records. To present a more complete picture of hospital quality, experts suggested development of composite measures that summarize quality across multiple indicators. A panel of experts reached consensus on a range of quality indicators for hospital-based care of opioid-exposed infants, with potential for use in national benchmarking, intervention studies, or hospital performance measurement.

Evidence-based interventions for identifying candidate quality indicators to assess quality of care in diabetic foot clinics: a scoping review.

Foot ulcers in people with diabetes are a serious complication requiring a complex management and have a high societal impact. Quality monitoring systems to optimize diabetic foot care exist, but a formal and more evidence-based approach to develop quality indicators (QIs) is lacking. We aimed to identify a set of candidate indicators for diabetic foot care by adopting an evidence-based methodology. A systematic search was conducted across four academic databases: PubMed, Embase CINAHL and Cochrane Library. Studies that reported evidence-based interventions related to organization or delivery of diabetic foot care were searched. Data from the eligible studies were summarized and used to formulate process and structure indicators. The evidence for each candidate QI was described in a methodical and transparent manner. The review process was reported according to the "Preferred Reported Items for Systematic reviews and Meta-Analysis" (PRISMA) statements and its extension for scoping reviews. In total, 981 full-text articles were screened, and 322 clinical studies were used to formulate 42 candidate QIs. An evidence-based approach could be used to select candidate indicators for diabetic foot ulcer care, relating to the following domains: wound healing interventions, peripheral artery disease, offloading, secondary prevention, and interventions related to organization of care. In a further step, the feasibility of the identified set of indicators will be assessed by a multidisciplinary panel of diabetic foot care stakeholders.

Development of quality indicators for pregnancy and childbirth in patients with systemic lupus erythematosus.

A quality indicator (QI) for the treatment of systemic lupus erythematosus (SLE) during pregnancy and childbirth that is useful for sharing standard treatment policies has not yet been developed. This study aimed to develop a QI for SLE associated with pregnancy and childbirth. To identify candidate QIs, we conducted a systematic literature review on the development of QIs for SLE related to pregnancy and childbirth and on clinical practice guidelines. Candidate QI items were extracted from the final selected articles, and a first evaluation, panel meeting, and second evaluation were conducted to determine whether the candidate items were appropriate as QIs. Items for which all panel members reached a consensus were designated pregnancy and childbirth-related SLE QIs. Four articles on SLE QI development and 28 practice guidelines were listed through abstract/text screening. Based on these studies, 52 candidate QIs were extracted that were limited to items related to pregnancy and childbirth and 41 items were selected on which all panel members agreed. We developed pregnancy-related SLE QIs using the RAND/UCLA method and selected 41 items, which could be used clinically.

Identifying candidate quality indicators of tools that support the practice of knowledge translation: a scoping review protocol.

The objective of this scoping review is to identify and characterize relevant knowledge translation methods tools (those that provide guidance for optimized knowledge translation practice) to uncover candidate quality indicators to inform a future quality assessment tool for knowledge translation strategies. Knowledge translation strategies (defined as including knowledge translation interventions, tools, and products) target various knowledge users, including patients, clinicians, researchers, and policy-makers. The development and use of strategies that support knowledge translation practice have been rapidly increasing, making it difficult for knowledge users to decide which to use. There is limited evidence-based guidance or measures to help assess the overall quality of knowledge translation strategies. Empirical and non-empirical documents will be considered if they explicitly describe a knowledge translation methods tool and its development, evaluation or validation, methodological strengths or limitations, and/or use over time. The review will consider a knowledge translation methods tool if it falls within at least one knowledge translation domain (ie, implementation, dissemination, sustainability, scalability, integrated knowledge translation) in the health field. We will conduct a systematic search of relevant electronic databases and gray literature. The search strategy will be developed iteratively by an experienced medical information specialist and peer-reviewed with the PRESS checklist. The search will be limited to English-only documents published from 2005 onward. Documents will be independently screened, selected, and extracted by 2 researchers. Data will be analyzed and summarized descriptively, including the characteristics of the included documents, knowledge translation methods tools, and candidate quality indicators. Open Science Framework ( https://osf.io/chxvq ).

A population-based study of administrative data linkage to measure melanoma surgical and pathology quality.

Continuous quality improvement is important for cancer systems. However, collecting and compiling quality indicator data can be time-consuming and resource-intensive. Here we explore the utility and feasibility of linked routinely collected health data to capture key elements of quality of care for melanoma in a single-payer, universal health care setting. This pilot study utilized a retrospective population-based cohort from a previously developed linked administrative data set, with a 65% random sample of all invasive cutaneous melanoma cases diagnosed 2007-2012 in the province of Ontario. Data from the Ontario Cancer Registry was utilized, supplemented with linked pathology report data from Cancer Care Ontario, and other linked administrative data describing health care utilization. Quality indicators identified through provincial guidelines and international consensus were evaluated for potential collection with administrative data and measured where possible. A total of 7,654 cases of melanoma were evaluated. Ten of 25 (40%) candidate quality indicators were feasible to be collected with the available administrative data. Many indicators (8/25) could not be measured due to unavailable clinical information (e.g. width of clinical margins). Insufficient pathology information (6/25) or health structure information (1/25) were less common reasons. Reporting of recommended variables in pathology reports varied from 65.2% (satellitosis) to 99.6% (body location). For stage IB-II or T1b-T4a melanoma patients where SLNB should be discussed, approximately two-thirds met with a surgeon experienced in SLNB. Of patients undergoing full lymph node dissection, 76.2% had adequate evaluation of the basin. We found that use of linked administrative data sources is feasible for measurement of melanoma quality in some cases. In those cases, findings suggest opportunities for quality improvement. Consultation with surgeons offering SLNB was limited, and pathology report completeness was sub-optimal, but was prior to routine synoptic reporting. However, to measure more quality indicators, text-based data sources will require alternative approaches to manual collection such as natural language processing or standardized collection. We recommend development of robust data platforms to support continuous re-evaluation of melanoma quality indicators, with the goal of optimizing quality of care for melanoma patients on an ongoing basis.

Measuring the Quality of Care for Older Adults With Multimorbidity: Results of the MULTIqual Project.

Background and ObjectivesProviding health care for older adults with multimorbidity is often complex, challenging, and prone to fragmentation. Although clinical decision making should take into account treatment interactions, individual burden, and resources, current approaches to assessing quality of care mostly rely on indicators for single conditions. The aim of this project was to develop a set of generic quality indicators for the management of patients aged 65 and older with multimorbidity that can be used in both health care research and clinical practice.Research Design and MethodsBased on the findings of a systematic literature review and eight focus groups with patients with multimorbidity and their family members, we developed candidate indicators. Identified aspects of quality were mapped to core domains of health care to obtain a guiding framework for quality-of-care assessment. Using nominal group technique, indicators were rated by a multidisciplinary expert panel (n = 23) following standardized criteria.ResultsWe derived 47 candidate quality indicators from the literature and 4 additional indicators from the results of the focus groups. The expert panel selected a set of 25 indicators, which can be assigned to the levels of patient factors, patient–provider communication, and context and organizational structures of the conceptual framework.Discussion and ImplicationsWe developed a comprehensive indicator set for the management of multimorbidity that can help to highlight areas with potential for improving the quality of care and support application of multimorbidity guidelines. Furthermore, this study may serve as a blueprint for participatory designs in the development of quality indicators.

Patient, Family, and Clinician Perspectives on End-of-Life Care Quality Domains and Candidate Indicators for Adolescents and Young Adults With Cancer

End-of-life care quality indicators specific to adolescents and young adults (AYAs) aged 12 to 39 years with cancer have not been developed. To identify priority domains for end-of-life care from the perspectives of AYAs, family caregivers, and clinicians, and to propose candidate quality indicators reflecting priorities. This qualitative study was conducted from December 6, 2018, to January 5, 2021, with no additional follow-up. In-depth interviews were conducted with patients, family caregivers, and clinicians and included a content analysis of resulting transcripts. A multidisciplinary advisory group translated priorities into proposed quality indicators. Interviews were conducted at the Dana-Farber Cancer Institute, Kaiser Permanente Northern California, Kaiser Permanente Southern California, and an AYA cancer support community (lacunaloft.org). Participants included 23 AYAs, 28 caregivers, and 29 clinicians. Stage IV or recurrent cancer. Care priorities. Interviews were conducted with 23 patients (mean [SD] age, 29.3 [7.3] years; 12 men [52%]; 18 White participants [78%]), 28 family caregivers (23 women [82%]; 14 White participants [50%]), and 29 clinicians (20 women [69%]; 13 White participants [45%]). Caregivers included 22 parents (79%), 5 spouses or partners (18%), and 1 other family member (4%); the 29 clinicians included 15 physicians (52%), 6 nurses or nurse practitioners (21%), and 8 social workers or psychologists (28%). Interviews identified 7 end-of-life priority domains: attention to physical symptoms, attention to quality of life, psychosocial and spiritual care, communication and decision-making, relationships with clinicians, care and treatment, and independence. Themes were consistent across the AYA age range and participant type. Although some domains were represented in quality indicators developed for adults, unique domains were identified, as well as AYA-specific manifestations of existing domains. For example, quality of life included global quality of life; attainment of life goals, legacy, and meaning; support of personal relationships; and normalcy. Within communication and decision-making, domains included communication early in the disease course, addressing prognosis and what to expect at the end of life, and opportunity for AYAs to hold desired roles in decision-making. Care and treatment domains relevant to cancer therapy, use of life-prolonging measures, and location of death emphasized the need for preference sensitivity rather than a standard path. This finding differs from existing adult indicators that propose that late-life chemotherapy, intensive measures, and hospital death should be rare. The findings of this qualitative study suggest that AYAs with cancer have priorities for care at the end of life that are not fully encompassed in existing indicators for adults. Use of new indicators for this young population may better reflect patient- and family-centered experiences of quality care.

Improving the quality of care for patients requiring continuous renal replacement therapy.

Continuous renal replacement therapy (CRRT) is the preferred extracorporeal kidney support therapy employed to support critically ill patients with acute or chronic kidney dysfunction in intensive care units. Significant heterogeneity in CRRT practice exists in part due to variable logistics, resources, and scarcity of evidence-based CRRT practices. Importantly, homogenization of practice patterns by developing substantial evidence and effective dissemination among providers is essential for optimizing CRRT practices. The emphasis on quality of CRRT delivery has prompted identification of potential quality indicators, development of multifaceted quality improvement initiatives, effective computer science utilization, and a surge of multidisciplinary quality assurance teams that advocate for "best" CRRT practices. This manuscript provides an overview of quality improvement methodologies and reviews candidate quality indicators of CRRT and the impact of quality improvement on enhancing CRRT delivery practices.

Introduction of Quality Indicators into Radiotherapy Departments in Japan

This study investigates the quality indicators (QIs) of medical care that are expected to be introduced to radiotherapy departments in Japan and evaluates whether the QIs reflect the characteristics of the treatment facilities. For this purpose, a questionnaire survey was administered to radiotherapy treatment facilities in Japan. A consensus of early QI candidates was obtained from the panel members. The characteristics identified in the candidate QIs were subdivided into 140 items covering 27 domains of medical-care contents in radiotherapy departments. These 140 items were compiled into a questionnaire, which was administered to 15 treatment facilities in Japan. The primary results indicated that 36 items in five domains are useful QI contents. The secondary findings indicated that the provision of advanced radiotherapy to several patients, the waiting time, and the radiotherapy initiated depend on the manpower of the departmental staff.

The development of quality indicators for systemic lupus erythematosus using electronic health data: A modified RAND appropriateness method

Objective: Quality indicators (QIs) are tools that standardize evaluations in terms of the minimum acceptable quality of care, presumably contributing for the better management of patients with systemic lupus erythematosus (SLE). This study aimed to develop QIs for SLE using electronic health data.Methods: The modified RAND/UCLA Appropriateness Method was used to develop the QIs. First, a literature review was conducted. Second, the candidate QI items that were available to be evaluated using the electronic health data were extracted. Third, the appropriateness of the items was assessed via rating rounds and panelists’ discussions.Results: We found 3621 articles in the initial search. Finally, 34 studies were reviewed, from which 17 potential indicators were extracted as candidate QIs. Twelve indicators were selected as the final QI set through the process of appropriateness. The median appropriateness of these 12 indicators was at least 7.5, and all of them were without disagreement. The QI included assessment of disease activity, treatment of SLE, drug toxicity monitoring, treatment of glucocorticoid complications, and assessment of SLE complications.Conclusion: We formulated 12 QIs for the assessment of patients with SLE based on electronic medical data. Our QI set would be a practical tool as a quality measure.

Postoperative wound dehiscence after laparotomy: a useful healthcare quality indicator? A cohort study based on Norwegian hospital administrative data

ObjectivesPostoperative wound dehiscence (PWD) is a serious complication to laparotomy, leading to higher mortality, readmissions and cost. The aims of the present study are to investigate whether risk adjusted PWD...

Quality of Care Indicators in Patients with Sickle Cell Disease (SCD): Influenza Vaccination and Routine Eye Examination Are Associated with Outpatient Utilization but Not Acute Hospital Care, Whereas Comorbidity Indexes Are Strongly Associated with Both

Although SCD-related mortality has improved over the last 3 decades, mortality from acute pulmonary causes remains relatively unchanged.(Payne, 2017)Acute chest syndrome (ACS) occurs in patients with SCD of all ages and influenza infection is one of its cause. Although influenza vaccination is recommend by the CDC for patients with SCD, and was proposed as a quality of care indicator(Wang CJ, 2010), its use is not mentioned in 2014 SCD NIH guidelines. This study examined influenza vaccination in patients with SCD as a potential marker of quality of care delivery. The study population included black individuals aged 1 to < 60 years, continuously enrolled on Medicaid from January 1 2008 until July 31 2009 in Georgia (CMS Data Use Agreement: 25585) to identify disparities in influenza vaccination uptake among Medicaid enrollees with a diagnosis of SCD. Patients with one inpatient claim or two outpatient claims with an ICD-9 code for SCD were considered to have a diagnosis of SCD. The association between influenza vaccination and health care utilization was measured by logistic regression models. Outcomes included: outpatient visits (<median outpatient visits versus >=median outpatient visits), emergency department (ED) visit or any hospitalization and influenza specific hospitalization during the study period. The fully adjusted models included the following covariates: age, gender, rural status, residing in two index counties (Fulton, Rockdale; a state sponsored SCD center is located in Fulton county), eye examination (as per SCD NIH guidelines), Elixhauser and a SCD comorbidity index. For the SCD comorbidity index, a score of one was given for each of the following 5 groups of sickle cell disease complications: CNS complications (>=1 diagnosis of stroke, TIA or epilepsy/recurrent seizures); cardio pulmonary complications (>=1 diagnosis of chronic pulmonary heart disease, pulmonary hypertension, malaise and fatigue, edema, chest pain or hypoxemia); kidney disease (>=1 diagnosis of chronic kidney disease/renal failure, proteinuria), avascular necrosis or ulcer of lower limbs (adapted from Afenyi-Annan, 2008, Candrilli. 2011, Elmariah. 2014). A total of 1544 patients with SCD were included in the study. Having influenza vaccination (aOR=1.77, p-value=0.004) and eye examination (aOR=1.74, p-value=0.0004) were significantly associated with higher number of outpatient visits. There was no statistically significant association between receipt of influenza vaccination with ED visits and hospitalizations. Hospitalizations for influenza were also not significantly associated with vaccination status, possibly due to ineffectiveness of the vaccine during the 2009 H1N1 pandemic. Women were more likely to be seen as outpatients or to be hospitalized when compared to men. No gender differences were observed in ED visits. Residence in a poor or rural county had no significant association with health care utilization. A modest decrease in ED utilization was noted among patients not residing in the two index counties (OR=0.71, p-value=0.045). Both comorbidity indices were strongly associated with increased healthcare utilization. Strength of association between the Elixhauser index and hospital admissions was greater than with outpatient visits, whereas the reverse was noted with the SCD index (Elixhauser index score >=2 outpatient aOR=6.8, p-value <.0001, ED aOR=4.07, p-value <.0001, ED aOR=23.65, p-value <.0001; SCD index score >=1 outpatient aOR=4.20, p-value <.0001, ED aOR=2.82, p-value <.0001, ED aOR=2.57, p-value <.0001). Although adult age was strongly associated with utilization in unadjusted models, it was not significant in the fully adjusted models. This suggests that increases in utilization observed when children transition to adulthood may be driven by increasing disease severity over time. In conclusion, outpatient-based candidate quality indicators of care examined (influenza vaccination and eye examination), were associated with increased outpatient utilization, but not acute visits or hospitalizations. Co-morbidity indexes have significant confounding effects on outpatient and hospital utilization. Administrative data based quality indicators of care such as influenza vaccination, as well as SCD specific comorbidity indexes warrant further studies as these may help better understand optimal allocation of health care resources for patients with SCD. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

PD41-03 VALIDATED HOSPITAL QUALITY METRICS FOR RADICAL CYSTECTOMY: DISEASE-SPECIFIC AND CORRELATED TO LONG-TERM OUTCOMES

You have accessJournal of UrologyBladder Cancer: Invasive V1 Apr 2018PD41-03 VALIDATED HOSPITAL QUALITY METRICS FOR RADICAL CYSTECTOMY: DISEASE-SPECIFIC AND CORRELATED TO LONG-TERM OUTCOMES Abhinav Khanna, Olli Saarela, Keith Lawson, Andrew Stephenson, Georges-Pascal Haber, Byron Lee, Antonio Finelli, and Robert Abouassaly Abhinav KhannaAbhinav Khanna More articles by this author , Olli SaarelaOlli Saarela More articles by this author , Keith LawsonKeith Lawson More articles by this author , Andrew StephensonAndrew Stephenson More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , Byron LeeByron Lee More articles by this author , Antonio FinelliAntonio Finelli More articles by this author , and Robert AbouassalyRobert Abouassaly More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1942AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Centers for Medicare and Medicaid (CMS), private insurers, and many independent rating agencies are all measuring and publicly reporting hospital quality. However, commonly used quality metrics are not disease-specific and are rarely correlated with meaningful long term outcomes. We aim to develop and validate hospital quality metrics for radical cystectomy that are both disease-specific and correlated with meaningful outcomes. METHODS The National Cancer Database was utilized to identify hospitals performing radical cystectomy for bladder cancer from 2004-2014. A list of candidate quality indicators was developed based on literature review, and included performance of lymphadenectomy, receipt of neoadjuvant chemotherapy, receipt of continent urinary diversion, duration of time from diagnosis to cystectomy, inpatient length of stay and 30-day hospital readmission. Random effects models were used to identify quality indicators (QI's) with statistically significant between-hospital variance. Case-mix adjustment was performed by comparing observed to expected performance using the indirect standardization method. Outlier hospitals were defined as those that performed better or worse than expected based on z-test statistics. Outlier status was correlated to overall mortality using logistic and Cox regression analyses, respectively. RESULTS From 2004-2014, 48,341 patients underwent radical cystectomy at 1200 hospitals. Random effects models demonstrated significant between-hospital variance for all QI's even after adjusting for sociodemographic and clinical patient characteristics. Case-mix adjusted analyses revealed 1.7-25.4% of hospitals were categorized as outliers across the various QI's. High-performing outlier status was associated with lower overall mortality for performance of lymphadenectomy (HR 0.89, 95% confidence interval 0.83-0.95), receipt of neoadjuvant chemotherapy (HR 0.78, 0.66-0.93), receipt of continent urinary diversion (HR 0.80, 0.73-0.89), time from diagnosis to cystectomy (HR 0.90, 0.83-0.98), and 30-day hospital readmission (HR 0.84, 0.74-0.95). CONCLUSIONS Among patients undergoing radical cystectomy, there was significant variation in hospital performance across all quality indicators. High-performing outlier hospitals were associated with lower overall mortality. Our validation of these quality metrics provides support for their potential use by both policymakers and payers in efforts to measure hospital quality for high-cost surgical procedures. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e810 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Abhinav Khanna More articles by this author Olli Saarela More articles by this author Keith Lawson More articles by this author Andrew Stephenson More articles by this author Georges-Pascal Haber More articles by this author Byron Lee More articles by this author Antonio Finelli More articles by this author Robert Abouassaly More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Development of Quality Indicators to Address Abuse and Neglect in Home-Based Primary Care and Palliative Care.

To develop candidate quality indicators (QIs) for the quality standard of "addressing abuse and neglect" in the setting of home-based medical care. Systematic literature review of both the peer-reviewed and gray literature. Home-based primary and palliative care practices. Homebound community-dwelling older adults. Articles were identified to inform the development of candidate indicators of the quality by which home-based primary and palliative care practices addressed abuse and neglect. The literature guided the development of patient-level QIs and practice-level quality standards. A technical expert panel (TEP) representing exemplary home-based primary care and palliative care providers then participated in a modified Delphi process to assess the validity and feasibility of each measure and identify candidate QIs suitable for testing in the field. The literature review yielded 4,371 titles and abstracts that were reviewed; 25 publications met final inclusion criteria and informed development of nine candidate QIs. The TEP rated all but one of the nine candidate indicators as having high validity and feasibility. Translating the complex problem of addressing abuse and neglect into QIs may ultimately serve to improve care delivered to vulnerable home-limited adults who receive home-based medical care.

Quality indicators for the adult epilepsy monitoring unit.

Quality and safety in epilepsy monitoring units (EMUs) are of great importance because patients' seizures are induced rather than prevented in this hospital setting. However, the measurement and evaluation of quality and safety in EMUs are heterogeneous, as are practices and processes of care. To improve the measurement of quality and safety in EMUs, we sought to develop evidence-based and consensus-driven quality indicators, adhering to previously described methodologic standards. Candidate quality indicators were identified using a recent systematic review on quality and safety indicators in EMUs. These were supplemented by expert opinion to identify other indicators that had not been reported previously. The candidate quality indicators were then evaluated using a modified Delphi technique among a multidisciplinary EMU quality improvement team. Candidate indicators identified as important and feasible through the Delphi technique were then developed into quality metrics. Thirty-four candidate indicators were abstracted from 135 studies included in the earlier systematic review, and two additional candidate indicators were suggested through consensus from experts. Consensus was reached after two modified Delphi rounds for 25 quality indicators identified as important. These 25 indicators were then developed into quality metrics using a standardized data collection form and were deployed in an online database for systematic data capture and further analyses. These quality indicators have the potential to improve the reporting of quality and safety in EMUs through standardized measurement and evaluation of the quality and safety of care. The ultimate goal is improved patient care and clinical outcomes through safer and better care for people with epilepsy in the EMU.

A new quality indicator of colonoscopy: caveat emptor

Quality indicators of health care should measure endpoints that closely reflect patient outcomes. Further, they should be feasible to measure accurately in clinical practice and demonstrate evidence of variable performance. An additional important consideration is the potential for a candidate quality indicator to distort provider behavior in ways that could adversely affect patient outcomes or costs of care or that could be gamed, where the target measure is achieved but without reflecting high-quality care. “Gaming” in reference to quality indicators refers to behaviors that help satisfy the target set for the indicator but do not improve and are likely to detract from optimal or the most cost-effective patient care.

Building quality indicators for medication use in people aging with intellectual disabilities and behaviour disorders

Objectives: The quality of healthcare provided to people with intellectual disabilities, is under scrutiny. The aim of this project was to build quality indicators (QIs) that could be used to measure the quality of the medication use process for people with intellectual disabilities and behaviour disorders.Methods: Candidate Qls were developed using literature and guideline review and expert evaluation. The candidate Qls were submitted to a 32-member panel of multidisciplinary experts, from Ireland and the UK. The modified Delphi panel included psychiatrists, pharmacists, nursing personnel, speech and language therapists, geriatricians, psychologists and representation from academia, regulation and administration. Over 2 rounds the QIs were rated for importance, scientific soundness and feasibility on a 9 point likert scale. Consensus criteria were preset.Results: A total of 38 candidate QIs underwent Delphi scoring. QIs addressed patient experience, access to care, continuity of care, equity, patient safety, effectiveness, appropriateness and assessment. Following round one, 23 QIs were accepted, none were rejected and 15 were equivocal. A total of 30 candidate QIs were accepted following round 2. Selection criteria were raised to differentiate hierarchy of final list.Conclusions: This project was the first attempt to develop QIs for the medication use process in people with intellectual disabilities and behaviour disorders. They infer a judgement about the quality of care provided in the medication use process. They may become important definitions of quality care for people with intellectual disabilities and behaviour disorders and be useful for quality improvement in this vulnerable population.

Quality Metrics in Inpatient Neurology.

Quality of care in the context of inpatient neurology is the standard of performance by neurologists and the hospital system as measured against ideal models of care. There are growing regulatory pressures to define health care value through concrete quantifiable metrics linked to reimbursement. Theoretical models of quality acknowledge its multimodal character with quantitative and qualitative dimensions. For example, the Donabedian model distils quality as a phenomenon of three interconnected domains, structure-process-outcome, with each domain mutually influential. The actual measurement of quality may be implicit, as in peer review in morbidity and mortality rounds, or explicit, in which criteria are prespecified and systemized before assessment. As a practical contribution, in this article a set of candidate quality indicators for inpatient neurology based on an updated review of treatment guidelines is proposed. These quality indicators may serve as an initial blueprint for explicit quality metrics long overdue for inpatient neurology.

Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement.

Review of morbidities and mortality has been the primary method used to assess surgical quality by physicians, hospitals, and oversight agencies. The incidence of reoperation has been proposed as a candidate quality indicator for surgical care. The authors report a comprehensive assessment of reoperations within a neurosurgical department and discuss how such data can be integrated into quality improvement initiatives to optimize value of care delivery. All neurosurgical procedures performed in the main operating room or the outpatient surgery center at the Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center from July 2008 to December 2012 were considered for this study. Interventional radiology and stereotactic radiosurgery procedures were excluded. Early reoperations within 7 days of the index surgery were reviewed and their preventability status was evaluated. The incidence of early unplanned reoperation was 2.6% (occurring after 183 of 6912 procedures). More than half of the patients who underwent early unplanned reoperation initially had surgery for shunt-related conditions (34.4%) or intracranial tumor (23.5%). Shunt failure was the most common indication for early unplanned reoperation (34.4%), followed by postoperative bleeding (20.8%) and postoperative elevated intracranial pressure (9.8%). The average time interval (± SD) between the index surgery and reoperation was 3.0 ± 1.9 days. The average length of stay following reoperation was 12.1 ± 14.4 days. This study enabled an in-depth assessment of reoperations within an academic neurosurgical practice and identification of strategic opportunities for department-wide quality improvement initiatives. The authors provide a nuanced discussion regarding the use of absolute reoperations as a quality indicator for neurosurgical patient populations.

Quality of pharmaceutical care in surgical patients.

BackgroundSurgical patients are at risk for preventable adverse drug events (ADEs) during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements.ObjectiveTo assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements.MethodsFor this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam) participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients.ResultsThirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and ‘sensitivity to change’. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate). The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%). Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%).ConclusionsThis quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.