Gyanprakash Ketwaroo1,2, Robert Jay Sealock3, Steven Freedman4, Phil A Hart5, Mohamed Othman3, Wahid Wassef6, Peter Banks7, Santhi Swaroop Vege8, Timothy Gardner9, Dhiraj Yadav10, Sunil Sheth4, Fasiha Kanwal11,3. 1. Department of Medicine, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA. Gyanprakash.Ketwaroo@bcm.edu. 2. Department of Medicine, Baylor College of Medicine, Houston, TX, USA. Gyanprakash.Ketwaroo@bcm.edu. 3. Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 4. Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA. 5. Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 6. Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA, USA. 7. Brigham and Women's Hospital, Boston, MA, USA. 8. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. 9. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. 10. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 11. Department of Medicine, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA.
Abstract
BACKGROUND: Acute pancreatitis (AP) is a common and expensive condition. Improving quality of care in AP is vital to minimizing cost and improving patient outcomes. However, there has been little work accomplished toward developing and validating explicit quality indicators (QIs) in AP. AIMS: To define quality of care in patients with AP by developing explicit QIs using standardized techniques. METHODS: We used the UCLA/RAND Delphi panel approach to combine a comprehensive literature review with the collective judgment of experts to identify a defined set of process measures for AP. RESULTS: We produced 164 candidate QIs after a comprehensive literature review. After Delphi review, 75 had a median rating ≥ 7. We excluded 11 QIs where the disagreement index exceeded 1.0 and combined indicators overlapping in content to produce a final list of 22 QIs. Overall, 8 QIs related to diagnosis, prevention, or determination of etiology, 2 QIs focused on determination of severity, 3 QIs captured fluid resuscitation, 2 QIs measured nutrition, 1 QI use of antibiotics, and 6 QIs captured endoscopic or surgical management. CONCLUSIONS: We have developed 22 QIs spanning the spectrum of AP management including diagnosis, risk stratification, and pharmacological and endoscopic therapy. These QIs will facilitate future quality improvement by practitioners and organizations who treat patients with AP and further identify areas that are amenable to improvement to enhance patient care. We anticipate that this QI set will represent the first step in determining a framework for demonstrating value in the care of patients with AP.
BACKGROUND:Acute pancreatitis (AP) is a common and expensive condition. Improving quality of care in AP is vital to minimizing cost and improving patient outcomes. However, there has been little work accomplished toward developing and validating explicit quality indicators (QIs) in AP. AIMS: To define quality of care in patients with AP by developing explicit QIs using standardized techniques. METHODS: We used the UCLA/RAND Delphi panel approach to combine a comprehensive literature review with the collective judgment of experts to identify a defined set of process measures for AP. RESULTS: We produced 164 candidate QIs after a comprehensive literature review. After Delphi review, 75 had a median rating ≥ 7. We excluded 11 QIs where the disagreement index exceeded 1.0 and combined indicators overlapping in content to produce a final list of 22 QIs. Overall, 8 QIs related to diagnosis, prevention, or determination of etiology, 2 QIs focused on determination of severity, 3 QIs captured fluid resuscitation, 2 QIs measured nutrition, 1 QI use of antibiotics, and 6 QIs captured endoscopic or surgical management. CONCLUSIONS: We have developed 22 QIs spanning the spectrum of AP management including diagnosis, risk stratification, and pharmacological and endoscopic therapy. These QIs will facilitate future quality improvement by practitioners and organizations who treat patients with AP and further identify areas that are amenable to improvement to enhance patient care. We anticipate that this QI set will represent the first step in determining a framework for demonstrating value in the care of patients with AP.
Authors: P G Lankisch; R Mahlke; T Blum; A Bruns; D Bruns; P Maisonneuve; A B Lowenfels Journal: Am J Gastroenterol Date: 2001-07 Impact factor: 10.864
Authors: Lucio Gullo; Marina Migliori; Attila Oláh; Gyula Farkas; Philippe Levy; Constantine Arvanitakis; Paul Lankisch; Hans Beger Journal: Pancreas Date: 2002-04 Impact factor: 3.327
Authors: Steven M Asch; Elizabeth A McGlynn; Liisa Hiatt; John Adams; Jennifer Hicks; Alison DeCristofaro; Roland Chen; Pablo LaPuerta; Eve A Kerr Journal: BMC Cardiovasc Disord Date: 2005-01-07 Impact factor: 2.298