Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study

Petrosyan, Yelena; Barnsley, Jan; Kuluski, Kerry; Liu, Barbara; Wodchis, Walter P.

doi:10.1371/journal.pone.0208888

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…), physician visits (OHIP) and validated disease cohorts. The specific sets of process of care measures, as judged to be relevant by the Delphi panel,21 were used for assessing clinical aspects of ambulatory care among older adults with four selected disease combinations. The development of process of care measures integrated clinical expertise with scientific evidence form systematic research.…”

Section: Discussionmentioning

confidence: 99%

“…This study uses process and outcome measures for diabetes with comorbidities. A specific set of process and outcome measures was developed by means of a Delphi panel21 for assessing the quality of care for older adults with each particular disease combination in ambulatory care settings (table 1). Delphi participants purposefully selected a list of indicators in the context of assessing care of older adults with diabetes and specific comorbid chronic conditions.…”

Section: Methodsmentioning

confidence: 99%

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Evaluating quality of overall care among older adults with diabetes with comorbidities in Ontario, Canada: a retrospective cohort study

et al. 2020

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ObjectivesThis study aimed to: (1) explore whether the quality of overall care for older people with diabetes is differentially affected by types and number of comorbid conditions and (2) examine the association between process of care measures and the likelihood of all-cause hospitalisations.DesignA population-based, retrospective cohort study.SettingThe province of Ontario, Canada.ParticipantsWe identified 673 197 Ontarians aged 65 years and older who had diabetes comorbid with hypertension, chronic ischaemic heart disease, osteoarthritis or depression on 1 April 2010.Main outcome measuresThe study outcome was the likelihood of having at least one hospital admission in each year, during the study period, from 1 April 2010 to 3 March 2014. Process of care measures specific to older adults with diabetes and these comorbidities, developed by means of a Delphi panel, were used to assess the quality of care. A generalised estimating equations approach was used to examine associations between the process of care measures and the likelihood of hospitalisations.ResultsThe study findings suggest that patients are at risk of suboptimal care with each additional comorbid condition, while the incidence of hospitalisations and number of prescribed drugs markedly increased in patients with 2 versus 1 selected comorbid condition, especially in those with discordant comorbidities. The median continuity of care score was higher among patients with diabetes-concordant conditions compared with those with diabetes-discordant conditions, and it declined with additional comorbid conditions in both groups. Greater continuity of care was associated with lower hospital utilisation for older diabetes patients with both concordant and discordant conditions.ConclusionsThere is a need for focusing on improving continuity of care and prioritising treatment in older adults with diabetes with any multiple conditions but especially in those with diabetes-discordant conditions (eg, depression).

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Evaluating quality of overall care among older adults with diabetes with comorbidities in Ontario, Canada: a retrospective cohort study

et al. 2020

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“…As with any research, there are some limitations to this study that need to be acknowledged. First, to prevent peer influence in a Delphi study, each member of the panel of experts should not know about the others [57]. However, the members of the expert panel in this study were mainly approached during international conferences.…”

Section: Domains Itemsmentioning

confidence: 99%

Developing a tool for measuring the disaster resilience of healthcare rescuers: a modified Delphi study

Mao

Loke

2020

Scand J Trauma Resusc Emerg Med

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Background Disaster resilience is an essential personal characteristics of health rescue workers to respond to disasters in an effective manner, and maintain a state of adaptation after deployment. It is essential for disaster managers to recruit, assess, and prepare healthcare rescuers with this characteristic. A specific tool for measuring the disaster resilience of healthcare rescuers has yet to be devised. Objective The purpose of this study was to establish the content validity of a tool for measuring the disaster resilience of disaster rescue workers. Methods A modified Delphi approach was employed. Experts in disaster work and research were invited to rate the domains and items of a prototype tool for measuring disaster resilience in healthcare rescue workers. The panel of experts rated the relevance of the items using a 4-point Likert scale. The median and interquartile range, as well as the level of agreement, were calculated for each item using the Kendall coefficient W, to assess the consensus of the experts. The content validity index (CVI) was calculated to assess the content validity of this tool. Results A total of 22 and 21 experts were involved in the first and second rounds of this modified Delphi study (response rate of 91.7 and 95.5%), respectively. After two rounds of expert query, an eight-domain and 27-item disaster resilience measuring tool was established. The median range of all of the included items was 3.50 to 4.00 and the interquartile range was 0.00 to 1.00, and all items achieved ≥85% agreement. The Kendall coordination coefficient W was 0.21 and 0.33 in the first and second rounds, respectively, with P < 0.01. The I-CVI ranged from 0.85 to 1.0, while the S-CVI/UA and S-CVI /Ave were 0.69 and 0.97, respectively. Conclusion Consensus was reached on a disaster resilience measuring tool covering 27 items. The content validity of this tool for measuring the disaster resilience of healthcare rescuers was excellent. This tool is validated and ready to be tested in a pilot study to assess its psychometric properties.

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“…Some studies provided detailed information about the development process of the quality of care indicators, while other studies included indicators that had never been used in practice. Studies varied widely in their reporting of validity and reliability of proposed indicators and not all provided evidence that the indicators are 10,14,21,22,28,30,35,36,38,39,41,49,54,58,61,62 Varies by study but includes low risk of bias studies 10,36,54 Varies by study, but includes low risk of bias studies Varies by study, but includes low risk of bias studies 13,[19][20][21]24,35,48,49 Varies by study; one 49 reports on criterion met (discriminant power); one 46 reports on panel consensus on indicators; one 15 used focus groups to establish criteria; one 38 rated the usefulness and meaningfulness…”

Section: Setting Age Category Patient Characteristicmentioning

confidence: 99%

Quality Indicators for High-Need Patients: a Systematic Review

et al. 2022

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BACKGROUND: Healthcare systems are increasingly implementing programs for high-need patients, who often have multiple chronic conditions and complex social situations. Little, however, is known about quality indicators that might guide healthcare organizations and providers in improving care for high-need patients. We sought to conduct a systematic review to identify potential quality indicators for high-need patients. METHODS: This systematic review (CRD42020215917) searched PubMed, CINAHL, and EMBASE; guideline clearing houses ECRI and GIN; and Google scholar. We included publications suggesting, evaluating, and utilizing indicators to assess quality of care for high-need patients. Critical appraisal of the indicators addressed the development process, endorsement and adoption, and characteristics, such as feasibility. We standardized indicators by patient population subgroups to facilitate comparisons across different indicator groups. RESULTS: The search identified 6964 citations. Of these, 1382 publications were obtained as full text, and 53 studies met inclusion criteria. We identified over 1700 quality indicators across studies. Quality indicator characteristics varied widely. The scope of the selected indicators ranged from detailed criterion (e.g., "annual eye exam") to very broad categories (e.g., "care coordination"). Some publications suggested disease condition-specific indicators (e.g., diabetes), some used condition-independent criteria (e.g., "documentation of the medication list in the medical record available to all care agencies"), and some publications used a mixture of indicator types. DISCUSSION: We identified and evaluated existing quality indicators for a complex, heterogeneous patient group. Although some quality indicators were not disease-specific, we found very few that accounted for social determinants of health and behavioral factors. More research is needed to develop quality indicators that address patient risk factors.

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Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study

Cited by 10 publications

References 30 publications

Evaluating quality of overall care among older adults with diabetes with comorbidities in Ontario, Canada: a retrospective cohort study

Evaluating quality of overall care among older adults with diabetes with comorbidities in Ontario, Canada: a retrospective cohort study

Developing a tool for measuring the disaster resilience of healthcare rescuers: a modified Delphi study

Quality Indicators for High-Need Patients: a Systematic Review

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