quality indicators · dr suleman aktaa. specialty trainee in cardiology. clinical research fellow....
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Dr Suleman AktaaSpecialty Trainee in CardiologyClinical Research FellowLeeds, UK
Quality Indicators
27 January 2020
#EORP@SulAktaa
• None
Declaration of Interest
The degree to which services increase the likelihood of desired outcomesand are consistent with current knowledge
Quality of Care
Lohr KN (ed.). National Academy Press, 1990
Quality of Care
Safety
EBM
Patient-centeredness
Timeliness of care
Equity
Efficiency
National Academies Press 2001
Framework to measure components of the quality of health care
Quality Indicators
Spertus JA, et al. Circulation. 2005;111:1703–12
Quality Indicator
Scientifically acceptable
Useable
Feasible (measurable)
Important
National Quality Forum
• Why to measure quality of care
• How to measure quality of care
• Challenges to overcome
Objectives
• Why to measure quality of care
• How to measure quality of care
• Where can we do better
Measure to Improve
T B Dondo et al. BMJ Open 2016;6:e011600
TR: 0.44, 95% CI: 0.41–0.45
Dondo T, et al. Eur Heart J Acute Cardiovasc Care. 2017;6:412–420
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Jernberg T, et al. JAMA. 2011; 305: 1677-1684
N Engl J Med 2018; 379:948-957
Measure to improve
Quality of Care measurement
• Why to measure quality of care
• How to measure quality of care
• Where can we do better
Quality Indicators
Schiele F, Gale CP, et al. Eur Heart J Acute Cardiovasc Care. 2017 Feb; 6(1):34-59
Bebb O, et al. Eur Heart J. 2017;38(13):974–982.
Bebb O, et al. Eur Heart J. 2017;38(13):974–982.
QIs Development
Phase 1Identify domains and
dimension of care
Phase 2Literature & CPGs
Review
Phase 3Modified Delphi process
(patient involvement)
Phase 4External validation &
feasibility study
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Modified from MacLean, et al. N Engl J Med 2018 378:1757-1761
QI selection
Modified Delphi Process
Inclusion Disagreement Exclusion
Normand SL, et al. Int J Qual Health Care 1998;10:247–260
QIs & OMs for AF
PROJECTSTART
JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
Q1Systematic ReviewGuideline Review
Q2Consensus on QI/OM
(Delphi process)
Q3Manuscript Preparation
Q4Manuscript Review
and Submission
July, 18th
Working Group Launch
August, 30th
Common searchstrategy defined
September, 30th
Systematic review– QI-OM list
October, 31st
2-3 rounds of Delphi
November, 30th
QI & OM definedCase-mix definition
Manuscript Development
Early January1st Draft circulated
Document readyfor externalreview process
Feedback fromexternalreviewers
2nd Review submitted to Journal
Final submission to Journal
EP Journal Acceptance
QIs & OMs for AF
Quality Indicators
Measure to improve
Quality Indicators
• Why to measure quality of care
• How to measure quality of care
• Where can we do better
Quality Indicators
ESC Guidelines
Fanaroff A, et al. JAMA. 2019;321(11):1069-1080
House of Care.
Maren Batalden et al. BMJ Qual Saf 2016;25:509-517
Maren Batalden et al. BMJ Qual Saf 2016;25:509-517
“What is the matter with you?”
“What matters to you?”
Engaging Patients
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Bhatt DL, et al. JACC. 2015;66(20):2230–45
QIs and Registries
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Clinical Research
CPG
QIs recommended
Clinical Practice
QIs measured
EORP
Modified from Califf R, et al. J Am Coll Cardiol. 2002;40:1895–901
Feedback
Education
Collaboration Outcomes
Patient involvement
