Acute Pancreatitis Task Force on Quality: Development of Quality Indicators for Acute Pancreatitis Management

Abstract

INTRODUCTION: Detailed recommendations and guidelines for acute pancreatitis (AP) management currently exist. However, quality indicators (QIs) are required to measure performance in health care. The goal of the Acute Pancreatitis Task Force on Quality was to formally develop QIs for the management of patients with known or suspected AP using a modified version of the RAND/UCLA Appropriateness Methodology. METHODS: A multidisciplinary expert panel composed of physicians (gastroenterologists, hospitalists, and surgeons) who are acknowledged leaders in their specialties and who represent geographic and practice setting diversity was convened. A literature review was conducted, and a list of proposed QIs was developed. In 3 rounds, panelists reviewed literature, modified QIs, and rated them on the basis of scientific evidence, bias, interpretability, validity, necessity, and proposed performance targets. RESULTS: Supporting literature and a list of 71 proposed QIs across 10 AP domains (Diagnosis, Etiology, Initial Assessment and Risk Stratification, etc.) were sent to the expert panel to review and independently rate in round 1 (95% of panelists participated). Based on a round 2 face-to-face discussion of QIs (75% participation), 41 QIs were classified as valid. During round 3 (90% participation), panelists rated the 41 valid QIs for necessity and proposed performance thresholds. The final classification determined that 40 QIs were both valid and necessary. DISCUSSION: Hospitals and providers managing patients with known or suspected AP should ensure that patients receive high-quality care and desired outcomes according to current evidence-based best practices. This physician-led initiative formally developed 40 QIs and performance threshold targets for AP management. Validated QIs provide a dependable quantitative framework for health systems to monitor the quality of care provided to patients with known or suspected AP.

Quantitating Quality Measurements of Acute Pancreatitis Management

“…The graded validity had to be in the "definitely" valid range in order to be ultimately considered by the group. It is fascinating that many of the QIs developed by Tarnasky and his colleagues [8] overlapped or were the same as those developed in the current study by Ketwaroo et al [7]. Again, these ranged from appropriate diagnosis to grading of severity, antibiotic and fluid management, to the use of invasive testing such as ERCP.…”

“…Concurrently and independently, an investigative team was assembled with a similar mission ultimately identifying 41 QIs based on literature review and which were considered valid, in the sense that the QI measures quality of care and has the potential to improve clinical practice [8]. The graded validity had to be in the "definitely" valid range in order to be ultimately considered by the group.…”

Management of severe acute pancreatitis

“…Recently, a multidisciplinary expert panel supported by the American College of Gastroenterology formally developed and published a comprehensive set of 40 quality indicators for acute pancreatitis in several domains including diagnosis, causes, initial assessment, risk stratification, initial management, ERCP use, nutrition, drug treatment, management of early complications, surgery, and structure of care 82. These quality indicators are meant to enable hospitals and providers to identify opportunities for improving medical care and outcome for patients with pancreatitis.…”

Outcome of patients with acute severe necrotizing pancreatitisin a dedicated hepato-biliary unit of Pakistan

“…Severity of pancreatitis was defined according to the revised Atlanta classification whereas, pancreatic necrosis was diagnosed as ≥30% non-enhancing areas in pancreatic parenchyma on Contrast-Enhanced-CT. 3 The size of the fluid or walled off collection was determined by measuring the largest cross-sectional diameter of the largest collection radiologically and obtaining the modified Computed Tomography Severity Index (CTSI). 3 Infected necrosis was defined as culture positive aspirates from the collections 6 or the presence of gas in the collection(s) on CT scan in the presence of systemic manifestation of sepsis. 5 Recovery was defined as asymptomatic patients, tolerating oral feeds with normal inflammatory markers while off analgesia and antibiotics for three days.…”