Developing ‘high impact’ guideline-based quality indicators for UK primary care: a multi-stage consensus process

Abstract

BackgroundQuality indicators (QIs) are an important tool for improving clinical practice and are increasingly being developed from evidence-based guideline recommendations. We aimed to identify, select and apply guideline recommendations to develop a set of QIs to measure the implementation of evidence-based practice using routinely recorded clinical data in United Kingdom (UK) primary care.MethodsWe reviewed existing national clinical guidelines and QIs and used a four-stage consensus development process to derive a set of ‘high impact’ QIs relevant to primary care based upon explicit prioritisation criteria. We then field tested the QIs using remotely extracted, anonymised patient records from 89 randomly sampled primary care practices in the Yorkshire region of England.ResultsOut of 2365 recommendations and QIs originally reviewed, we derived a set of 18 QIs (5 single, 13 composites – comprising 2–9 individual recommendations) for field testing. QIs predominantly addressed chronic disease management, in particular diabetes, cardiovascular and renal disease, and included both processes and outcomes of care. Field testing proved to be critical for further refinement and final selection.ConclusionsWe have demonstrated a rigorous and transparent methodology to develop a set of high impact, evidence-based QIs for primary care from clinical guideline recommendations. While the development process was successful in developing a limited set of QIs, it remains challenging to derive robust new QIs from clinical guidelines in the absence of established systems for routine, structured recording of clinical care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0350-6) contains supplementary material, which is available to authorized users.

Variations in achievement of evidence-based, high-impact quality indicators in general practice: An observational study

“…In earlier work [8], we identified a set of evidence-based quality indicators (QIs) based on criteria including: burden of illness (e.g. prevalence, severity); potential for significant patient benefit (e.g.…”

Impact of Disease Prevalence Adjustment on Hospitalization Rates for Chronic Ambulatory Care–Sensitive Conditions in Germany

“…Development and implementation of appropriate quality indicators is not trivial and faces challenges worldwide (Lester, Hannon, and Campbell ; Rushforth et al. ; Saust et al. ).…”

“…and faces challenges worldwide (Lester, Hannon, and Campbell 2011;Rushforth et al 2015;Saust et al 2016). While in the German health care system a structured set of quality indicators is mandatory for all German hospitals, the use of indicators for outpatient care shows potential for improvement (Albrecht, Loos, and Otten 2013;de Crupp e et al 2015;Hermes-Moll et al 2015).…”

Are characteristics of team members important for quality management of chronic patients at primary care level?

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“…Assessing quality of care through quality indicators is paramount (Mainz, 2003) and has already become standard for working in family practice in several countries (Kringos et al, 2013;Reid, Friedberg, Adams, McGlynn, & Mehrotra, 2010;Rushforth et al, 2015;Seddon, Marshall, Campbell, & Roland, 2001). Various quality indicators are being used (Simou, Pliatsika, Koutsogeorgou, & Roumeliotou, 2015), and in some countries, performance-based pay, based on quality indicators, has been introduced (Buetow, 2008;Campbell et al, 2007;Van Herck et al, 2010).…”