Introduction: Variation in adherence to management guidelines for inflammatory bowel disease (IBD) suggests variable quality of care. Quality indicators (QIs) can be developed to measure the structure, processes, and outcomes of health care delivery. The RAND/UCLA appropriateness method was used to develop a set of process and outcome QIs to define quality of care for IBD.
Methods: Guidelines and position papers for IBD published from 2006 to 2011 were reviewed for potential QIs, which were rated by a multidisciplinary panel. Potential process and outcome QIs were discussed at 3 moderated in-person meetings, with pre-meeting and post-meeting confidential electronic voting. Panelists rated the validity and feasibility of QIs on a 1 through 9 scale; disagreement was assessed using a validated index. QIs rated above 8 were selected for the final set.
Results: More than 500 potential process QIs were extracted from guidelines. Following ratings and discussion by the first panel, 35 process QIs were selected for literature review. After the second panel, 10 process QIs were included in the final set. Candidate outcome QIs were then derived from physician, nurse, and patient input and ratings, in addition to outcomes associated with candidate process QIs. None of the top QIs exhibited disagreement.
Conclusions: A set of QIs for IBD was developed with expert interpretation of the literature and multidisciplinary input. Outcome QIs focused largely on remission and quality of life, whereas process QIs were aimed at therapeutic optimization and patient safety. Evaluation of these QIs in clinical practice is needed to assess the correlation of performance on process QIs with performance on outcome QIs.
1Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
2David Geffen School of Medicine at UCLA, Los Angeles, California
3Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
4New Hampshire and Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
5Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California
6CURE Digestive Diseases Research Center, Los Angeles, California
7UCLA/VA Center for Outcomes Research and Education, Los Angeles, California
8Department of Gastroenterology, Minnesota Gastroenterology, Minneapolis, Minnesota
9Department of Surgery, Mayo Clinic, Rochester, Minnesota
10Icahn School of Medicine at Mount Sinai, New York, New York
11Department of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
12Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio
13JSchool of Medicine & Nursing, Johns Hopkins University, Baltimore, Maryland
14Loeb & Loeb, Los Angeles, California
15Department of Medicine and Gastroenterology, University of Chicago, Chicago, Illinois
16Department of Pediatrics
17Departments of Medicine, Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina
18Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
19Department of Gastroenterology, VA San Francisco, San Francisco, California
20Minnesota Gastroenterology, Minneapolis, Minnesota
21Atlanta Gastroenterology Associates, Atlanta, Georgia
22The Dr. Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Mt. Sinai School of Medicine, New York, New York.
Reprints: Gil Y. Melmed, MD, 8730 Alden Dr., #203B, Los Angeles, CA 90048 (e-mail: email@example.com).
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ibdjournal.org).
Supported by the Crohn’s and Colitis Foundation of America.
Author disclosures are available in the Acknowledgements.
Received October 19, 2012
Accepted October 30, 2012