The professional perspective on patient involvement in the development of quality indicators: a qualitative analysis using the example of chronic heart failure in the German health care setting

Figures & data

Table 1 Patient-relevant aspects of care, as mentioned by the interviewed experts, correlated with the final set of quality indicators for the NDMG HF

Final set of quality indicators developed from the NDMG HFa	Patient-relevant aspects of care according to expert opinionb
Diagnostics
1. ECG numerator: number of patients who underwent an ECG (12 recordings) after presumptive diagnosis of chronic heart failure denominator: every patient with the presumptive diagnosis of chronic heart failure	(Correct) diagnosis by general practitioners and adequate NYHA classification
2. Echocardiography numerator: number of patients with two-dimensional transthoracic echocardiography and Doppler flow measurement with left ventricular function analysis denominator: all patients with the presumptive diagnosis of chronic heart failure
General treatment strategy
1. Documentation of consultation on physical activity numerator: documentation of consultation on physical activity denominator: all eligible patients (risk groups are to be specified and excluded) with chronic heart failure and NYHA I-III 2. Documentation consultation on weight monitoring numerator: number of patients with documented consultation on weight monitoring and the necessity of informing their practitioner about short-term weight gain denominator: all symptomatic patients with chronic heart failure	Consultation quality (content and implementation, eg, consideration of patients’ needs and abilities, comprehensibility for lay persons)
Medical therapy
1. ACE inhibitors numerator: number of patients with ACE inhibitors denominator: all symptomatic patients and all asymptomatic patients with a proven cardiac ejection fraction <35% and no contraindications for ACE inhibitors 2. Beta-blockers numerator: number of patients with beta-blockers denominator: all patients with NYHA II-IV and no contraindications	Adequate medication (according to guidelines)
Instrumental therapy
1. Cardiac resynchronization numerator: number of patients with cardiac resynchronization through bi-ventricular stimulation denominator: all patients with NYHA III-IV and cardiac ejection fraction <35%, left ventricular dilatation, sinus rhythm, optimal medical therapy according to the guidelines and QRS >120 ms	–
Follow-up
1. Serum electrolytes/renal function numerator: number of patients with regularly measured serum electrolytes and renal function (at least every 6 months) denominator: all patients with chronic heart failure by unchanged medication and unchanged NYHA-classification during that time	Outcome measurement (definition of therapy goals and review)/follow-up concerning aggravation and decompensation
Care management and interfaces
1. Referral to a cardiologist numerator: number of patients referred to a cardiologist denominator: all patients with the presumptive diagnosis of chronic heart failure	Referral to specialists/interdisciplinary collaboration/interface management
	Other (only found in expert interviews)b – Doctor-patient-interaction (eg, attention)/communication (eg, information) – Inclusion of the family/social circle – Waiting time (ambulatory care)/for appointments with specialists – Quality of life – Patient satisfaction – Courses (global)/about self-care/self-monitoring – Screening for depression – Coordination of different DMP/provision for co-/multi-morbidity – Continuity of the therapeutic team

Notes:

a Ratio-based quality indicators derived in a formal process from the NDMG HF

b as mentioned in telephone interviews.

Abbreviations: NDMG, National Disease Management Guideline; HF, heart failure; ECG, electrocardiogram; NYHA, New York Heart Association; ACE, angiotensin-converting-enzyme; DMP, disease management program.