Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey

Abstract

Objective: Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients.

Methods and Results: A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI.

Conclusions: A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.

Keywords:

• Quality improvement
• quality indicators
• health care
• myocardial infarction
• Delphi technique

Acknowledgements

This study is part of the Care Pathway for Acute Coronary Syndrome (CP4ACS) project on STEMI quality improvement by European Pathway Association. We thank the members of the Belgian Dutch Care Pathway Network for their participation in this research.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the European Pathway Association (EPA). EPA thanks AstraZeneca for the provision of an unrestricted educational grant to the Care Pathways for Acute Coronary Syndrome (CP4ACS) quality improvement research project.