Development of quality indicators for chronic obstructive pulmonary disease (COPD): A modified RAND appropriateness method

Abstract

RATIONALE: Quality indicators are evidence-based structures, processes and outcomes of care associated with such a strong benefit that failure to address them reduces likelihood of good health outcomes.

OBJECTIVES: Our objective was to use synthesized evidence and diverse expert opinion to create a comprehensive set of evidence-based COPD quality indicators spanning the health care continuum from prevention to outcome.

METHODS: COPD quality indicators were developed using a modified RAND Appropriateness Method consisting of a systematic review of the medical literature followed by a Delphi method survey. The review took place in three parts: searching first for existing high quality COPD quality indicators, then for meta-analyses and systematic reviews and, lastly, for individual studies. The Delphi method had an expert panel rate and discussed the indicators in an in-person meeting followed by rounds of electronic surveys until consensus was reached.

RESULTS: The systematic review produced 26 highly rated quality indicators, and 10,002 titles for further assessment. Of these, 32 full-text articles provided supporting evidence for 39 additional COPD quality indicators, for 65 in total. After rounds of review by the expert panel, a final list of 33 quality indicators was endorsed by all.

CONCLUSIONS: We generated a comprehensive set of 33 evidence-based COPD quality indicators. These can be used to measure current quality of COPD health and healthcare, develop and implement strategies to improve it and otherwise provide a foundation for quality improvement. Before using in other jurisdictions, these made-in-Canada indicators should be validated to ensure they address their unique circumstances.

RÉSUMÉ

JUSTIFICATION: Les indicateurs de qualité sont des structures, des processus et des issues de soins fondés sur des données probantes associés à des effets bénéfiques tellement importants que le fait de ne pas en tenir compte diminue la possibilité de bonnes issues de santé.

OBJECTIFS: Notre objectif était de résumer les données probantes et les diverses opinions d’experts afin de créer un ensemble complet d’indicateurs de qualité pour la MPOC fondé sur des données probantes couvrant toute la gamme des soins de santé, de la prévention aux résultats.

M´ETHODES: Des indicateurs de qualité pour la MPOC ont été élaborés à l’aide de la méthode RAND relative à la pertinence.

R´ESULTATS: Cette revue systématique a produit 26 indicateurs de qualité ayant reçu une note élevée et 10 002 titres devant être évalués davantage. Parmi ceux-ci, 32 articles complets présentaient des données probantes en faveur de 39 indicateurs de qualité supplémentaires pour la MPOC, pour un total de 65. Après plusieurs cycles d’examen par le comité d’experts, une liste finale de 33 indicateurs de qualité a été approuvée par tous.

CONCLUSIONS: Nous avons produit une gamme complète de 33 indicateurs de qualité pour la MPOC. Ces indicateurs peuvent être utilisés pour mesurer la qualité des soins de santé relatifs à la MPOC, élaborer et mettre en oeuvre des stratégies pour les améliorer et servir de base à l’amélioration de la qualité. Avant de les utiliser dans d’autres juridictions, ces indicateurs élaborés au Canada devraient être validés pour s’assurer qu’ils conviennent aux circonstances particulières de ces juridictions.

Keywords:

• Chronic obstructive pulmonary disease (COPD)
• health care
• quality indicators
• quality assurance
• quality improvement

Acknowledgments

The authors would like to thank all the members of the expert panel for their participation and expertise: Robin Brown, Madonna Ferrone, Roger Goldstein, Donna Goodridge, Samir Gupta, Alan Kaplan, John Li, Marilyn Sorochan, Ann Taite, Itamar Tamari, Laurie Taylor, Shannon Walker, and Pamela Wilton. We would also like to thank our moderator for the in-person expert panel consensus meeting, Sara Han of the Ontario Lung Association. Furthermore, we would like to thank Gail Dechman for her assistance with reviewing the quality of identified studies.

Disclosure statement

The authors report no conflict of interest.

Authors' contributions

All authors made substantial contributions to the conception or design of the work, AG and GM contributed to the acquisition and analysis of data; all authors contributed to the interpretation of data; all drafted the work or revised it critically for important intellectual content; all gave final approval of the version submitted; and all agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Additional information

Funding

This work was supported by a MOHLTC Health System Research Fund Capacity Award, the Ontario Ministry of Health and Long-Term Care (MOHLTC), and in-kind contributions from the Ontario Lung Association. This study was also supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. A.S. Gershon is supported by a Canadian Institutes of Health Research New Investigator Award and was supported by a PSI Graham Farquharson Knowledge Translation Fellowship while working on this study. K.T. is supported by a Research Scholar Award from the Department of Family and Community Medicine at the University of Toronto.