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Acute Pancreatitis Task Force on Quality

Development of Quality Indicators for Acute Pancreatitis Management

Vivian, Elaina MPH, CPHQ1; Cler, Leslie MD, FACP, CPE1; Conwell, Darwin MD, MS2; Coté, Gregory A. MD, MSCI, MS3; Dickerman, Richard MD, FACS1; Freeman, Martin MD, FACG, FASGE4; Gardner, Timothy B. MD, MS, FACG5; Hawes, Robert H. MD, FACG6; Kedia, Prashant MD, FASGE1; Krishnamoorthi, Rajesh MD7; Oduor, Hellen MBChB, MPH, CPHQ, LSSGB1; Pandol, Stephen J. MD8; Papachristou, Georgios I. MD, PhD, FACG, FASGE, AGAF9; Ross, Andrew MD, FASGE7; Sethi, Amrita MD, MSc, FASGE10; Varadarajulu, Shyam MD11; Vege, Santhi Swaroop MD, FACP, MACG, AGAF12; Wassef, Wahid MD, MPH, FACG13; Wilcox, C. Mel MD, MSPH, FACG14; Whitcomb, David C. MD, PhD, FACG9; Wu, Bechien U. MD, MPH15; Yadav, Dhiraj MD, MPH9; Ellison, Ashton MD1; Habash, Samar MD16; Rastegari, Sheila MD16; Reddy, Rathan MD1; Yen, Timothy MD1; Brooks, Mary Rachel MCN, RDN, LD1; Tarnasky, Paul MD, FACG1

doi: 10.14309/ajg.0000000000000264

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.

1Methodist Dallas Medical Center, Dallas, Texas, USA;

2The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;

3Medical University of South Carolina, Charleston, South Carolina, USA;

4University of Minnesota, Minneapolis, Minnesota, USA;

5Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA;

6Institute for Minimally Invasive Therapy, Florida Hospital, Orlando, Florida, USA;

7Virginia Mason Medical Center, Seattle, Washington, USA;

8Cedars-Sinai Medical Center, Los Angeles, California, USA;

9University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA;

10Columbia University Medical Center, New York Presbyterian, New York, New York, USA;

11Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA;

12Mayo Clinic, Rochester, Minnesota, USA;

13University of Massachusetts Memorial Medical Center, Worchester, Massachusetts, USA;

14University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA;

15Kaiser Permanente Los Angeles, Los Angeles, California, USA;

16AtlantiCare Regional Medical Center, Atlantic City, New Jersey, USA; and

17American College of Gastroenterology and ACG Institute's Acute Pancreatitis Task Force on Quality.

Correspondence: Paul Tarnasky, MD, FACG. E-mail:

SUPPLEMENTARY MATERIAL accompanies this paper at

Received November 15, 2018

Accepted March 08, 2019

© The American College of Gastroenterology 2019. All Rights Reserved.
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