Afrin N Kamal1, Priya Kathpalia2, Fouad Otaki3, Albert J Bredenoord4, Donald O Castell5, John O Clarke1, Gary W Falk6, Ronnie Fass7, C Prakash Gyawali8, Peter J Kahrilas9, Philip O Katz10, David A Katzka11, John E Pandolfino9, Roberto Penagini12,13, Joel E Richter14, Sabine Roman15, Edoardo Savarino16, George Triadafilopoulos1, Michael F Vaezi17, Marcelo F Vela18, David A Leiman19. 1. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA. 2. Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, California, USA. 3. Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, USA. 4. Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Amsterdam, the Netherlands. 5. Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA. 6. Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine Philadelphia, Pennsylvania, USA. 7. Division of Gastroenterology and Hepatology, Department of Medicine, The MetroHealth Medical Center and Case Western Reserve, Cleveland, Ohio, USA. 8. Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA. 9. Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. 10. Division of Gastroenterology, Weill Cornell School of Medicine, New York, NY, USA. 11. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA. 12. Department of Pathophysiology and Transplantation, Università degli Studi of Milan, Milan, Italy. 13. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy. 14. Division of Digestive Diseases & Nutrition, University of South Florida College of Medicine, Tampa, Florida, USA. 15. Digestive Physiology, Hospices Civils de Lyon, Hospital E Herriot and Lyon I University, Lyon, France. 16. Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. 17. Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 18. Division of Gastroenterology, Mayo Clinic Arizona, Scottsdale, Arizona, USA. 19. Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina, USA.
Abstract
BACKGROUND: The management of achalasia has improved due to diagnostic and therapeutic innovations. However, variability in care delivery remains and no established measures defining quality of care for this population exist. We aimed to use formal methodology to establish quality indicators for achalasia patients. METHODS: Quality indicator concepts were identified from the literature, consensus guidelines and clinical experts. Using RAND/University of California, Los Angeles (UCLA) Appropriateness Method, experts in achalasia independently ranked proposed concepts in a two-round modified Delphi process based on 1) importance, 2) scientific acceptability, 3) usability, and 4) feasibility. Highly valid measures required strict agreement (≧ 80% of panelists) in the range of 7-9 for across all four categories. KEY RESULTS: There were 17 experts who rated 26 proposed quality indicator topics. In round one, 2 (8%) quality measures were rated valid. In round two, 19 measures were modified based on panel suggestions, and experts rated 10 (53%) of these measures as valid, resulting in a total of 12 quality indicators. Two measures pertained to patient education and five to diagnosis, including discussing treatment options with risk and benefits and using the most recent version of the Chicago Classification to define achalasia phenotypes, respectively. Other indicators pertained to treatment options, such as the use of botulinum toxin for those not considered surgical candidates and management of reflux following achalasia treatment. CONCLUSIONS & INFERENCES: Using a robust methodology, achalasia quality indicators were identified, which can form the basis for establishing quality gaps and generating fully specified quality measures.
BACKGROUND: The management of achalasia has improved due to diagnostic and therapeutic innovations. However, variability in care delivery remains and no established measures defining quality of care for this population exist. We aimed to use formal methodology to establish quality indicators for achalasia patients. METHODS: Quality indicator concepts were identified from the literature, consensus guidelines and clinical experts. Using RAND/University of California, Los Angeles (UCLA) Appropriateness Method, experts in achalasia independently ranked proposed concepts in a two-round modified Delphi process based on 1) importance, 2) scientific acceptability, 3) usability, and 4) feasibility. Highly valid measures required strict agreement (≧ 80% of panelists) in the range of 7-9 for across all four categories. KEY RESULTS: There were 17 experts who rated 26 proposed quality indicator topics. In round one, 2 (8%) quality measures were rated valid. In round two, 19 measures were modified based on panel suggestions, and experts rated 10 (53%) of these measures as valid, resulting in a total of 12 quality indicators. Two measures pertained to patient education and five to diagnosis, including discussing treatment options with risk and benefits and using the most recent version of the Chicago Classification to define achalasia phenotypes, respectively. Other indicators pertained to treatment options, such as the use of botulinum toxin for those not considered surgical candidates and management of reflux following achalasia treatment. CONCLUSIONS & INFERENCES: Using a robust methodology, achalasia quality indicators were identified, which can form the basis for establishing quality gaps and generating fully specified quality measures.
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