An explicit quality indicator set for measurement of quality of care in patients with cirrhosis

Fasiha Kanwal, Jennifer Kramer, Steven M. Asch, Hashem El-Serag, Brennan M R Spiegel, Steven Edmundowicz, Arun J. Sanyal, Jason A. Dominitz, Kenneth R. McQuaid, Paul Martin, Emmet B. Keeffe, Lawrence S. Friedman, Samuel B. Ho, Francisco Durazo, Bruce R. Bacon

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Background & Aims: Cirrhosis is a prevalent and expensive condition. With an increasing emphasis on quality in health care and recognition of inconsistencies in the management of patients with cirrhosis, we established a set of explicit quality indicators (QIs) for their treatment. Methods: We organized an 11-member, multidisciplinary expert panel and followed modified Delphi methods to systematically identify a set of QIs for cirrhosis. We provided the panel with a report that summarized the results of a comprehensive literature review of data linking candidate QIs to outcomes. The panel performed independent ratings of each candidate QI by using a standard 9-point RAND appropriateness scale (RAS) (ranging from 1 = not appropriate to 9 = most appropriate). The panel members then met, reviewed the ratings, and voted again by using an iterative process of discussion. The final set of QIs was selected; QIs had a median RAS >7, and panel members agreed on those selected. Results: Among 169 candidate QIs, the panel rated 41 QIs as valid measures of quality care. The selected QIs cover 6 domains of care including ascites (13 QIs), variceal bleeding (18 QIs), hepatic encephalopathy (4 QIs), hepatocellular cancer (1 QI), liver transplantation (2 QIs), and general cirrhosis care (3 QIs). Content coverage included prevention, diagnosis, treatment, timeliness, and follow-up. Conclusions: We developed an explicit set of evidence-based QIs for treatment of cirrhosis. These provide physicians and institutions with a tool to identify processes amenable to quality improvement. This tool is intended to be applicable in any setting where care for patients with cirrhosis is provided.

Original languageEnglish
Pages (from-to)709-717
Number of pages9
JournalClinical Gastroenterology and Hepatology
Volume8
Issue number8
DOIs
StatePublished - Aug 1 2010

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Quality of Health Care
Fibrosis
Hepatic Encephalopathy
Liver Neoplasms
Quality Improvement
Ascites
Liver Transplantation
Patient Care
Therapeutics
Hemorrhage
Physicians

Keywords

  • Cirrhosis
  • Delphi Panel
  • Performance Measures
  • Quality of Care

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Kanwal, F., Kramer, J., Asch, S. M., El-Serag, H., Spiegel, B. M. R., Edmundowicz, S., ... Bacon, B. R. (2010). An explicit quality indicator set for measurement of quality of care in patients with cirrhosis. Clinical Gastroenterology and Hepatology, 8(8), 709-717. https://doi.org/10.1016/j.cgh.2010.03.028

An explicit quality indicator set for measurement of quality of care in patients with cirrhosis. / Kanwal, Fasiha; Kramer, Jennifer; Asch, Steven M.; El-Serag, Hashem; Spiegel, Brennan M R; Edmundowicz, Steven; Sanyal, Arun J.; Dominitz, Jason A.; McQuaid, Kenneth R.; Martin, Paul; Keeffe, Emmet B.; Friedman, Lawrence S.; Ho, Samuel B.; Durazo, Francisco; Bacon, Bruce R.

In: Clinical Gastroenterology and Hepatology, Vol. 8, No. 8, 01.08.2010, p. 709-717.

Research output: Contribution to journalArticle

Kanwal, F, Kramer, J, Asch, SM, El-Serag, H, Spiegel, BMR, Edmundowicz, S, Sanyal, AJ, Dominitz, JA, McQuaid, KR, Martin, P, Keeffe, EB, Friedman, LS, Ho, SB, Durazo, F & Bacon, BR 2010, 'An explicit quality indicator set for measurement of quality of care in patients with cirrhosis', Clinical Gastroenterology and Hepatology, vol. 8, no. 8, pp. 709-717. https://doi.org/10.1016/j.cgh.2010.03.028
Kanwal, Fasiha ; Kramer, Jennifer ; Asch, Steven M. ; El-Serag, Hashem ; Spiegel, Brennan M R ; Edmundowicz, Steven ; Sanyal, Arun J. ; Dominitz, Jason A. ; McQuaid, Kenneth R. ; Martin, Paul ; Keeffe, Emmet B. ; Friedman, Lawrence S. ; Ho, Samuel B. ; Durazo, Francisco ; Bacon, Bruce R. / An explicit quality indicator set for measurement of quality of care in patients with cirrhosis. In: Clinical Gastroenterology and Hepatology. 2010 ; Vol. 8, No. 8. pp. 709-717.
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AU - Kramer, Jennifer

AU - Asch, Steven M.

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AU - Spiegel, Brennan M R

AU - Edmundowicz, Steven

AU - Sanyal, Arun J.

AU - Dominitz, Jason A.

AU - McQuaid, Kenneth R.

AU - Martin, Paul

AU - Keeffe, Emmet B.

AU - Friedman, Lawrence S.

AU - Ho, Samuel B.

AU - Durazo, Francisco

AU - Bacon, Bruce R.

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N2 - Background & Aims: Cirrhosis is a prevalent and expensive condition. With an increasing emphasis on quality in health care and recognition of inconsistencies in the management of patients with cirrhosis, we established a set of explicit quality indicators (QIs) for their treatment. Methods: We organized an 11-member, multidisciplinary expert panel and followed modified Delphi methods to systematically identify a set of QIs for cirrhosis. We provided the panel with a report that summarized the results of a comprehensive literature review of data linking candidate QIs to outcomes. The panel performed independent ratings of each candidate QI by using a standard 9-point RAND appropriateness scale (RAS) (ranging from 1 = not appropriate to 9 = most appropriate). The panel members then met, reviewed the ratings, and voted again by using an iterative process of discussion. The final set of QIs was selected; QIs had a median RAS >7, and panel members agreed on those selected. Results: Among 169 candidate QIs, the panel rated 41 QIs as valid measures of quality care. The selected QIs cover 6 domains of care including ascites (13 QIs), variceal bleeding (18 QIs), hepatic encephalopathy (4 QIs), hepatocellular cancer (1 QI), liver transplantation (2 QIs), and general cirrhosis care (3 QIs). Content coverage included prevention, diagnosis, treatment, timeliness, and follow-up. Conclusions: We developed an explicit set of evidence-based QIs for treatment of cirrhosis. These provide physicians and institutions with a tool to identify processes amenable to quality improvement. This tool is intended to be applicable in any setting where care for patients with cirrhosis is provided.

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