Measuring Quality Of Care Research Articles

A215 EVALUATING THE COMPARABILITY OF CARE FOR PERSONS ADMITTED TO TORONTO AREA HOSPITALS WITH ACUTE SEVERE ULCERATIVE COLITIS

Abstract Background Approximately 20% of patients with ulcerative colitis will experience an acute severe exacerbation requiring hospitalization. Acute severe ulcerative colitis (ASUC) is a medical emergency associated with significant morbidity and a mortality rate of 1%. Timely initiation of treatment and assessment of clinical response is critical in the management of ASUC. With an aim to reduce treatment variability and improve outcomes, multiple gastrointestinal societies have published guidelines highlighting recommendations for optimal care in ASUC. It remains unclear how closely these guidelines are implemented in clinical practice. Measuring adherence to these recommended processes of care may act as a surrogate measure for quality of care and a way to indirectly evaluate outcomes in the management of patients with ASUC. Studies have shown that even amongst experienced providers practice pattern variability exists. Identifying significant variations in the management of patients with ASUC will highlight where improvement in guideline dissemination and greater adherence is required. Purpose We sought to evaluate how quality of care indicators varied across 7 hospital sites for patients admitted ASUC in the Greater Toronto Area. Method Using GEMINI, a research collaborative that collects and analyses data from inpatient admissions at 7 Toronto area hospitals, we identified patients admitted to hospital with ASUC from June 2016-December 2019. Hospital sites were further categorized into 3 hospital types; 1 IBD specialty centre (ISC), 3 other academic centres (AC) and 3 community centres (CC). Process measures assessed included proportion tested for C-reactive protein at baseline and following treatment initiation, duration of corticosteroid use, timing and initiation of biologic agents, rates of venous thromboembolism prophylaxis and opioid use. Outcome measures included hospital length of stay, rates of colectomy and mortality. Result(s) 765 hospitalizations were included in the study; 320 occurring at ISC, 308 at AC and 137 at CC. Corticosteroid use on admission were highest at the ISC at 78% compared to 64% at AC and 63% at CC (p <0.001). Among those who received steroids on admission, 47% of patients remained on intravenous corticosteroids for at least 5 days in the ISC compared to 39% in AC and 75% in CC (p< 0.001). Initiation of biologic rescue therapy was highest at the ISC occurring in 37% of hospitalizations compared to 22% in AC and 23% in CC (p<0.001). In addition, VTE prophylaxis rates were highest at the ISC at 83% followed by 60% in AC and 45% in CC (p<0.001). Rates of colectomy were highest at ISC (12% of hospitalizations vs. 7% in AC). Conclusion(s) Greater adherence to indicators of quality of care were seen at the ISC compared to ACs and CCs, although patient outcomes assessed were not clearly different between sites. Further strategies are required to improve adherence to markers of quality care for patients admitted with ASUC. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Healthcare providers’ knowledge, attitude, and practice on quality of nutrition care in hospitals from a developing country: a multicenter experience

BackgroundDespite the fact that malnutrition can affect both recovery and outcome in acute care patients, little is known about malnutrition in Palestine, and even less is known about the assessment of malnutrition knowledge, attitudes, and practices (M-KAP) toward healthcare providers and nutrition care quality measures in hospitalized patients. Therefore, this study aimed to evaluate the M-KAP of physicians and nurses in routine clinical care and determine the influencing factors.MethodsFrom April 1 to June 31, 2019, cross-sectional research was performed at governmental (n = 5) and non-governmental (n = 4) hospitals in the North West Bank of Palestine. Data were collected using a structured self-administered questionnaire from physicians and nurses to collect information on knowledge, attitude, and practices related to malnutrition and nutrition care, alongside sociodemographic characteristics.ResultsA total of 405 physicians and nurses were participated in the study. Only 56% of participants strongly agreed that nutrition was important, only 27% strongly agreed that there should be nutrition screening, only 25% felt food helped with recovery, and around 12% felt nutrition as part of their job. Approximately 70% of participants said they should refer to a dietitian, but only 23% knew how and only 13% knew when. The median knowledge/attitude score was 71, with an IQR ranging from 65.00 to 75.00, and the median practice score was 15.00 with an IQR of 13.00–18.00. The mean knowledge attitude practice score was 85.62 out of 128 with SD (9.50). Respondents who worked in non-governmental hospitals showed higher practice scores (p < 0.05), while staff nurses and ICU workers showed the highest practice score (p < 0.001). Respondents with younger age categories, working in non-governmental hospitals in the ICU as practical and staff nurses, showed the highest KAP score (p < 0.05). Significance positive correlations were found between respondents’ knowledge/attitude and practice scores regarding the quality of nutrition care in hospitals (r = 0.384, p value < 0.05). In addition, the result also revealed that almost half of respondents believed that the most important barriers to inadequate intake of food at the bedside are related to food appearance, taste, and aroma of meals served (58.0%).ConclusionsThe research revealed that inadequate knowledge was perceived as a barrier to effective nutrition care to the patient. Many beliefs and attitudes do not always translate into practice. Although the M-KAP of physicians and nurses is lower than in some other countries/studies, it highlights a strong need for more nutrition professionals in the hospital and increasing nutrition education to improve nutrition care in hospitals in Palestine. Furthermore, establishing a nutrition task force in hospitals elaborated by dietitians as the unique nutrition care provider will assure to implementation of a standardized nutrition care process.

Development and Evaluation of Rehabilitation Service Areas for the United States

BackgroundGeographic areas have been developed for many healthcare sectors including acute and primary care. These areas aid in understanding health care supply, use, and outcomes. However, little attention has been given to developing similar geographic tools for understanding rehabilitation in post-acute care. The purpose of this study was to develop and characterize post-acute care Rehabilitation Service Areas (RSAs) in the United States (US) that reflect rehabilitation use by Medicare beneficiaries.MethodsA patient origin study was conducted to cluster beneficiary ZIP (Zone Improvement Plan) code tabulation areas (ZCTAs) with providers who service those areas using Ward’s clustering method. We used US national Medicare claims data for 2013 to 2015 for beneficiaries discharged from an acute care hospital to an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), long-term care hospital (LTCH), or home health agency (HHA). Medicare is a US health insurance program primarily for older adults. The study population included patient records across all diagnostic groups. We used IRF, SNF, LTCH and HHA services to create the RSAs. We used 2013 and 2014 data (n = 2,730,366) to develop the RSAs and 2015 data (n = 1,118,936) to evaluate stability. We described the RSAs by provider type availability, population, and traveling patterns among beneficiaries.ResultsThe method resulted in 1,711 discrete RSAs. 38.7% of these RSAs had IRFs, 16.1% had LTCHs, and 99.7% had SNFs. The number of RSAs varied across states; some had fewer than 10 while others had greater than 70. Overall, 21.9% of beneficiaries traveled from the RSA where they resided to another RSA for care.ConclusionsRehabilitation Service Areas are a new tool for the measurement and understanding of post-acute care utilization, resources, quality, and outcomes. These areas provide policy makers, researchers, and administrators with small-area boundaries to assess access, supply, demand, and understanding of financing to improve practice and policy for post-acute care in the US.

Comparison of acute ischemic stroke care quality before and during the COVID-19 pandemic in a private tertiary hospital in metro Manila, Philippines

Background: The Coronavirus Disease 2019 (COVID-19) pandemic had disrupted established medical care systems worldwide, especially for highly time-sensitive acute conditions such as stroke. Strategies to maintain the quality of stroke care during the COVID-19 outbreak are crucial to prevent indirect mortality and disability due to suboptimal care. Objective: We conducted a single center analysis to compare the time-based measures for acute ischemic stroke care quality before and during the COVID-19 pandemic. Methods: A retrospective study was done utilizing the Registry of Stroke Care Quality (RES-Q) database. All acute ischemic stroke patients who presented within 4.5 hours of symptom onset in Makati Medical Center were included. Patient characteristics, treatment received, in-hospital time-based measures of stroke care quality and clinical outcomes were compared between the two periods- pre-COVID-19 and COVID-19. Results: There were 151 patients during the pre-COVID-19 period and 108 patients during the COVID-19 period who presented to the hospital with acute ischemic strokes within 4.5 hours of symptom onset. There was significantly higher NIHSS scores on admission and MRS scores on discharge during the COVID-19 period. There was no significant difference in the door-to-scan time, door-to-needle time and door-to-groin time between the two periods. Conclusion: There is no significant change in the acute ischemic stroke care quality on the basis of in-hospital time-based measures: door-to-scan time, door-to-needle time, and door-to-groin time, between the pre-COVID-19 and COVID-19 periods. Further studies on pre-hospital challenges are recommended to identify specific targets for improvements in stroke care during pandemics.

Obesity and its associated factors in older nursing home residents in three European countries-Secondary data analyses from the "International Prevalence Measurement of Care Quality".

The prevalence of obesity has risen in recent decades and reached epidemic proportions worldwide. The proportion of those living with obesity is also increasing in nursing homes. This could impact the nursing care required, equipment and facilities provided, and morbidity in these settings. Limited evidence exists on clinical consequences of obesity in nursing home residents and their care. Therefore, the aim was to examine the rate and associated factors of obesity (BMI ≥30; class I (BMI 30.0-34.9kg/m2 ), class II (BMI 35.0-39.9kg/m2 ), and class III (BMI >40.0kg/m2 )) amongst older nursing home residents in European countries. We analysed data from 21,836 people who reside in nursing homes in Austria, the Netherlands, and the United Kingdom. They participated in the "International Prevalence Measurement of Care Quality", a cross sectional study between 2016 and 2019, where trained nurses interviewed the residents, reviewed care records, and conducted clinical examinations. A tested and standardised questionnaire comprised questions on demographic data, measured BMI, medical diagnosis according to ICD-10, and care dependency. Descriptive and logistic regression analyses were performed. Obesity rates were highest in Austria (17.1%) and lowest in the UK (13.0%) (p=.006). Residents with obesity were younger and less likely to be care dependent or living with dementia and had more often diabetes mellitus, endocrine, metabolic, and skin diseases compared to residents without obesity (p < .05). Most obese residents had obesity class I. Therefore, two subgroups were built (class I vs. class II + III). Residents with obesity class II + III were more frequently care dependent for mobility, getting dressed and undressed, and personal hygiene compared to residents with class I (p < .05). This study identified several factors that are associated with obesity amongst older nursing home residents in selected European countries. The division into obesity classes is important for planning targeted care according to the individual needs of nursing home residents.

Nurse Staffing and Veteran Outcomes in the Veterans Health Administration's Community Living Centers.

The demand for nursing care is rising in the long-term care setting. Nurse staffing is a crucial measure linked to health care quality measure outcomes. To assess for associations between nursing hours per patient day (NHPPD) and outcome measures in the Veterans Health Administration Community Living Centers. A retrospective data review of NHPPD and quality measures for 134 community living centers was conducted. Linear regression was used to assess for linear associations between average total NHPPD and 6 quality measures. A significant linear association was found between average total NHPPD and falls with major injury ( P = .02) and help with activities of daily living ( P = .01). No associations were found between nurse staffing and 4 other quality measures. This study adds to the body of literature regarding the impact of nurse staffing on quality measures.

Control del asma en niños, desigualdad socioeconómica y asistencia sanitaria

IntroductionSocioeconomic inequality (SEI) can adversely affect asthma control. The aim of this study was to establish the association of SEI with asthma control in children and caregiver quality of life. MethodsWe assessed socioeconomic status based on the area of residence, according to the at risk of poverty rate (ARPR). After stratifying the paediatric population of Castilla y León (an autonomous community in Spain) in ARPR tertiles, we selected participants by stratified random sampling, and identified children with asthma aged 6–14 years from the health records of primary care centres. We collected data through questionnaires completed by parents. The primary outcomes were asthma control and caregiver quality of life. We assessed their association with SEI, health care quality measures and individual factors (such as parental educational attainment) by means of multivariate regression models. ResultThe ARPR tertile was not associated with asthma control, quality of life or health care quality. A medium or high maternal educational attainment was associated with a lower risk of making an unscheduled or urgent visit (OR=.50; 95% CI: .27-.95; P=.034) and paternal educational attainment was associated with a lower risk of uncontrolled asthma (OR=.51; 95% CI: .28-.94; P=.030). ConclusionIn the sample under study, SEI assessed at the local level was not associated with asthma control in children. Other factors, such as parental educational attainment, may have a protective effect.

Care Delivery, Quality Measurement, and Quality Improvement in Nursing Homes: Issues and Recommendations from the National Academies’ Report on the Quality of Care in Nursing Homes

Care Delivery, Quality Measurement, and Quality Improvement in Nursing Homes: Issues and Recommendations from the National Academies’ Report on the Quality of Care in Nursing Homes

Patient-Reported Quality Measures for Palliative Care: The Time is now.

While progress has been made in the ability to measure the quality of hospice and specialty palliative care, there are notable gaps. A recent analysis conducted by Center for Medicare and Medicaid Services (CMS) revealed a paucity of patient-reported measures, particularly in palliative care domains such as symptom management and communication. The research team, consisting of quality measure and survey developers, psychometricians, and palliative care clinicians, used established state-of-the art methods for developing and testing patient-reported measures. We applied a patient-centered, patient-engaged approach throughout the development and testing process. This sequential process included 1) an information gathering phase; 2) a pre-testing phase; 3) a testing phase; and 4) an endorsement phase. To fill quality measure gaps identified during the information gathering phase, we selected two draft measures ("Feeling Heard and Understood" and "Receiving Desired Help for Pain") for testing with patients receiving palliative care in clinic-based settings. In the pre-testing phase, we used an iterative process of cognitive interviews to refine draft items and corresponding response options for the proposed measures. The alpha pilot test supported establishment of protocols for the national beta field test. Measures met conventional criteria for reliability, had strong face and construct validity, and there was diversity in program level scores. The measures received National Quality Forum (NQF) endorsement. These measures highlight the key role of patient voices in palliative care and fill a much-needed gap for patient-reported experience measures in our field.

Care Delivery, Quality Measurement, and Quality Improvement in Nursing Homes: Issues and Recommendations from the National Academies' Report on the Quality of Care in Nursing Homes.

Care Delivery, Quality Measurement, and Quality Improvement in Nursing Homes: Issues and Recommendations from the National Academies' Report on the Quality of Care in Nursing Homes.

Instrument Development and Validation of the Home Child Care Version of the Assessment for Quality Improvement

ABSTRACT Research Findings: Measures of home child care (HCC) quality are limited and tend to be labor intensive. This article presents the measure development process as well as psychometric, construct, convergent and discriminant validity analyses for the HCC version of the Assessment for Quality Improvement (HCC-AQI) measure. The HCC-AQI is part of a suite of observational measures developed by the City of Toronto for use in its early childhood education and care Quality Rating and Improvement System. It takes 60–90 minutes to administer, making it significantly more efficient than other measures. Instrument development involved expert panels and item response theory analyses. Exploratory factor analyses and internal consistency analyses indicate that the HCC-AQI measure can be categorized into two subscales: Physical Space and Experiences and Caregiver/Child Interactions. Moderately strong correlations between these subscales also support computing total HCC-AQI scores. Correlations between the Infant/Toddler and Early Childhood Home Observation for Measurement of the Environment and the Responsive Interactions for Learning scale were moderate, providing evidence for convergent validity. Practice or Policy: the HCC-AQI is a promising efficient measure of HCC that can be used for research as well as quality improvement and accountability purposes.

Predictive Analysis of Heterogenous Data for Hospital Readmission

Hospital readmission is a high priority health care quality measure. Diabetes patient readmission rate is increasing to such an extent that it becomes one of the major concerns for many hospitals. Many studies are conducted for finding the possible causes and risks of diabetes patient’s readmission. Reducing readmission rates of diabetes patients reduce health care costs. Here the relationship between diabetes and the various patient attributes are examined. Different prediction models were developed to predict the risk of readmission within 30 days among hospitalized patients with diabetes. The dataset used here contains more than 1 lakh observations and 56 features. They include a set of numerical attributes such as number of outpatient visits, number of emergency visits and time spent in hospital etc and a set of categorical data such as what type of admission the encounter faced , sets of drugs that the patient took etc. In this study we presented a scheme to identify high-risk patients and evaluated different machine learning algorithms. Results indicate that Adaboost with hyperparameter tuning is optimal for this task The results from the study help health care providers to improve diabetic care.

Integrating Patient and Expert Perspectives to Conceptualize High-Quality Palliative Cancer Care for Symptoms in the US Veterans Health Administration: A Qualitative Study.

Quality measurement is typically the domain of clinical experts and health system leaders; patient/caregiver perspectives are rarely solicited. We aimed to describe and integrate clinician and patient/caregiver conceptualizations of high-quality palliative symptom care for patients receiving care for advanced cancer within the US Veterans Health Administration in the context of existing quality measures. We conducted a secondary qualitative analysis of transcripts from prioritization discussions of process quality measures relevant to cancer palliative care. These discussions occurred during 2 modified RAND-UCLA appropriateness panels: a panel of 10 palliative care clinical expert stakeholders (7 physicians, 2 nurses, 1 social worker) and a panel of 9 patients/caregivers with cancer experience. Discussions were recorded, transcribed, and independently double-coded using an a priori logical framework. Content analysis was used to identify subthemes within codes and axial coding was used to identify crosscutting themes. Patients/caregivers and clinical experts contributed important perspectives to 3 crosscutting themes. First, proactive elicitation of symptoms is critical. Patients/caregivers especially emphasized importance of comprehensive and proactive screening and assessment, especially for pain and mental health. Second, screening and assessment alone is not enough; information elicited from patients must inform care. Measuring screening/assessment and management care processes separately has important limitations. Lastly, high-quality symptom management can be broadly defined if it is patient-centered; high-quality care takes an individualized approach and might include non-medical or non-pharmacological symptom management. Integrating the perspectives of clinical experts and patients/caregivers is critical for health systems to consider as they design and implement quality measures for palliative cancer care.

The Impact of Nurse Practitioner-Led Primary Care on Quality and Cost for Medicaid-Enrolled Patients in States With Pay Parity.

Studies have established that nurse practitioners (NPs) deliver primary care comparable to physicians in quality and cost, but most focus on Medicare, a program that reimburses NPs less than physicians. In this retrospective cohort study, we evaluated the quality and cost implications of receiving primary care from NPs compared to physicians in 14 states that reimburse NPs at the Medicaid fee-for-service (FFS) physician rate (i.e., pay parity). We linked national provider and practice data with Medicaid data for adults with diabetes and children with asthma (2012-2013). We attributed patients to primary care NPs and physicians based on 2012 evaluation & management claims. Using 2013 data, we constructed claims-based primary care quality measures and condition-specific costs of care for FFS enrollees. We estimated the effect of NP-led care on quality and costs using: (1) weighting to balance observable confounders and (2) an instrumental variable (IV) analysis using differential distance from patients' residences to primary care practices. Adults with diabetes received comparable quality of care from NPs and physicians at similar cost. Weighted results showed no differences between NP- and physician-attributed patients in receipt of recommended care or diabetes-related hospitalizations. For children with asthma, costs of NP-led care were lower but quality findings were mixed: NP-led care was associated with lower use of appropriate medications and higher rates of asthma-related emergency department visits but similar rates of asthma-related hospitalization. IV analyses revealed no evidence of differences in quality between NP- and physician-led care. Our findings suggest that in states with Medicaid pay parity, NP-led care is comparable to physician-led care for adults with diabetes, while associations between NP-led care and quality were mixed for children with asthma. Increased use of NP-led primary care may be cost-neutral or cost-saving, even under pay parity.

Public health service board members' understanding of care quality in residential aged care services.

ObjectiveThe objective of this study was to explore how health service boards understand care quality for older people living in public sector residential aged care services.MethodsSemi-structured interviews were undertaken with board members from six Victorian public health services responsible for the governance of 15 residential aged care services comprising over 850 beds. Transcripts were thematically analysed.ResultsEleven board members were interviewed. While committed to their governance and monitoring role, analysis suggests board members have a limited understanding of the residential aged care environment. They rarely visit and the information they receive about residential aged care is primarily clinical data (quality indicators) as well as sub-committee and staff reports. In addition to quality indicator data and reports, accreditation and complaints are used to measure care quality.ConclusionBoard members vary in their understanding of care quality in residential aged care settings. The exclusive focus on clinical indicators and accreditation as measures of quality reinforces this understanding. Visiting residential aged care services would provide understanding of the care environment and context for the information they receive. The provision of other metrics, such as consumer advocacy reports and residents' and families' experiences of care, would further assist board members to monitor care quality in these settings.

Health care quality measurement models

Una aproximación para medir el nivel de atención expresada en la calidad de servicio que se presta al paciente en los establecimientos de salud está referida al uso de modelos de medición, que en este artículo se describen desde la propuesta por Donabedian basado en la teoría general de sistemas evaluando estructura, proceso y resultado, pasando a segundo plano la percepción del paciente. Este modelo contrasta con el modelo Nórdico que enfatiza la imagen corporativa, con un balance entre el servicio esperado y la percepción del servicio, basado en el paradigma de la desconfirmación al igual que el modelo presentado por Nguyen. En esta última línea paradigmática se encuentra el modelo más notorio, SERVQUAL que contrasta las expectativas y la precepción del usuario de un servicio identificando brechas en base a las 5 dimensiones propuestas fiabilidad, seguridad, elementos tangibles, capacidad de respuesta, y la empatía, posteriormente basado en este modelo se propone el modelo SERVPERF, basada exclusivamente en la valoración de las percepciones. Posteriormente, se describen el modelo de Desempeño Evaluado que surge como un modelo alternativo al SERVQUAL sustituyendo las expectativas por el concepto de “punto ideal”; el Modelo Jerárquico Multidimensional que desarrolla una solución tridimensional para completar la modelización de la calidad de servicio. De igual manera el modelo multietapa de valoraciones de la calidad que identifica la disconformidad que existe las expectativas del cliente en relación al servicio y las percepciones de las características por niveles de componente.

SPECTRUM OF DEMENTIA IN OLDER HOSPICE RECIPIENTS

Abstract We know little about differences between hospice enrollees with dementia co-existing with another terminal illness (like cancer), those dying from dementia (as principal hospice diagnosis), and those dying with no dementia. We used the National Health Aging and Trends Study linked to Medicare claims to compare characteristics, hospice use patterns, and care quality ratings. Among 1,105 decedent hospice-enrollees age 70+, we found 39% were dying with coexisting dementia, 17% from dementia, and 44% without dementia. In adjusted analyses, those dying with dementia had similarly high rates of functional impairment, higher rates of clinical needs, and worse measures of care quality compared to elders dying from dementia. Hospice use patterns were different for elders dying with dementia compared to elders without dementia. In summary, 56% of older hospice enrollees have dementia, mostly in addition to another terminal illness. Their differing hospice experience implies changes are needed to hospice care and policy.

Relationship between Perceived Quality of Prenatal Care and Maternal/Infant Health Outcomes.

Studies have shown that quality of care affects patient health outcomes and well-being. In this study, we examine the relationship between perceived quality of prenatal care, birth outcomes, and postpartum depression (PPD). We use data from the third wave of the Listening to Mothers dataset (2013). After removing missing data, the analytic sample size included 2168 women. Through linear and logistic regression analyses, we test the following hypotheses: higher perceived quality of prenatal care will have a positive association with a likelihood of vaginal delivery and normal birth weight outcomes, and a negative association with a likelihood of preterm birth; and higher perceived quality of prenatal care will have a negative association with a likelihood of PPD risk. Women who perceived higher quality of prenatal care were significantly less likely to have a preterm birth relative to women who reported lower quality care. Women who reported (any) medical jargon during their prenatal visits were less likely to have a normal birth weight baby. Women who reported provider use of medical jargon, lower perceived quality of interaction with a prenatal care provider, and lower perceived quality of US maternity care in general were more likely to be at risk for PPD. Negative prenatal care experiences may exacerbate adverse patient outcomes. Positive prenatal care experiences may buffer/improve adverse outcomes. Quality of care measures were most consistently predictive of PPD outcomes. Providers should focus on improving the quality of prenatal care as one of the means to improve maternal and infant health and well-being.

Implementation of systematic safety checklists in a neurocritical care unit: a quality improvement study

Background and objectivesStructured and systematised checklists have been shown to prevent complications and improve patient care. We evaluated the implementation of systematic safety checklists in our neurocritical care unit (NCCU)...

Basic research for the development of quality measures of oral care in Korea

The aims of this study were to evaluate quality indicators that can be applied to the dental care delivery system in Korea. This study was performed with a three-step process. Firstly, authors searched for quality indica-tors developed in dentistry field. Among them, 80 quality indicators were selected as the indicators that used indental institutions, and then 33-item preliminary list was extracted through evaluation by 9 experts consisted of dental clinicians and professors (college of dentistry and department of dental hygiene). Based on this 33-item preliminary list, a Delphi process was conducted twice by a stakeholder group consisting of 17 panels (dentists, dental hygienists, dental technicians, professors of dental colleges, and dental hygiene professors). Each item of the preliminary list was classified into 5 domains of importance, relevance, feasibility, reliability, and sensitiv-ity. The panels were asked to rate from 0 to 3-point (very unnecessary - very appropriate) to the 5 domains of all items. As a result, the sealant treatment item received the most consent, and the item of whether unnecessary antibiotics is prescribed received the lowest preference. Among the 33 items, the items that received a score of 2.5 or higher were sealant, brushing, fluoride application, caries prevention, periodontal management, regularcheck-up, continuity of treatment, and evaluation of current symptoms. This study was performed as basic re-search. Based on international consensus on the definition of the quality of oral health care, development of newmeasures is necessary to produce quality indicators that suitable for the dental setting in Korea.