Quality in the provision of headache care. 2: defining quality and its indicators

Abstract

The objective of this study was to define “quality” of headache care, and develop indicators that are applicable in different settings and cultures and to all types of headache. No definition of quality of headache care has been formulated. Two sets of quality indicators, proposed in the US and UK, are limited to their localities and/or specific to migraine and their development received no input from people with headache. We first undertook a literature review. Then we conducted a series of focus-group consultations with key stakeholders (doctors, nurses and patients) in headache care. From the findings we proposed a large number of putative quality indicators, and refined these and reduced their number in consultations with larger international groups of stakeholder representatives. We formulated a definition of quality from the quality indicators. Five main themes were identified: (1) headache services; (2) health professionals; (3) patients; (4) financial resources; (5) political agenda and legislation. An initial list of 160 putative quality indicators in 14 domains was reduced to 30 indicators in 9 domains. These gave rise to the following multidimensional definition of quality of headache care: “Good-quality headache care achieves accurate diagnosis and individualized management, has appropriate referral pathways, educates patients about their headaches and their management, is convenient and comfortable, satisfies patients, is efficient and equitable, assesses outcomes and is safe.” Quality in headache care is multidimensional and resides in nine essential domains that are of equal importance. The indicators are currently being tested for feasibility of use in clinical settings.

Headache service quality: evaluation of quality indicators in 14 specialist-care centres

“…The centres were diverse in level of care, setting and structure and operated within different cultures and health systems. Implementation was readily acceptable and all centres were able to collect data quickly and efficiently in the nine domains deemed important for quality evaluation [3, 8]. Across centres, findings were comparable.…”

“…The principal limitation was that we did not collect any information about the quality of the treatment itself. In a full quality evaluation, external expert reviews would check additional quality indicators relating to treatment in each centre by retrospective examination of the records [8]. However, we did not have the resources to undertake this part.…”

“…As a collaborative group of health-services researchers and headache specialists, we first defined quality in the context of headache care [7], then formulated a set of quality indicators based on this definition that might be applied to headache care across countries, cultures and settings [8]. The ultimate purpose was that inadequacies in headache care worldwide might be recognized and rectified.…”

Quality indicators in headache care: an implementation study in six Italian specialist-care centres

“…This requires a means of identifying such deficiencies. In a collaborative project with the European Headache Federation (EHF), LTB used various qualitative research methods to develop, through focus-group consultations and expert consensus, a definition of quality applicable to headache services.“ Good-quality headache care achieves accurate diagnosis and individualized management, has appropriate referral pathways, educates patients about their headaches and their management, is convenient and comfortable, satisfies patients, is efficient and equitable, assesses outcomes and is safe ” [5]. …”

Diagnosis and treatment of migraine: Recommendations of the Russian experts

“…Профилактическое лечение считается эффективным, если в течение 3 мес терапии число дней с ГБ уменьшается на 50% и более от исходного уровня [91][92][93][94][95][96] (табл. 7).…”