Article type
Year
Abstract
Background: Healthcare quality indicators are direct measures of the appropriateness of care provided in a particular health condition. Evidence-based indicators are built from clinical recommendations (CR) supported by robust evidence. The complexity of building healthcare indicators depends on the characteristics of the condition studied, as well as on the existing evidence on management of the condition.
Objectives: To compare the process and results of developing evidence-based healthcare quality indicators in two different clinical specialties, obstetrics & delivery (OBD) and peripheral vascular disease (PAD).
Methods: The OBD and PAD projects followed a similar methodology, described elsewhere. Systematic reviews (SR) were identified through bibliographic searches, and their risk of bias was assessed. Clinical recommendations were built from low risk of bias SR, and their quality of evidence was assessed. Only those CR supported by high quality evidence were used to define indicators. The proposed indicators were assessed to discard those measuring controversial interventions (e.g. unclear benefit-harm balance) or of limited clinical relevance.
Results: There was less available evidence for OBD than for PAD, but such evidence was of higher quality and led to more clinical recommendations (see Table 1). In the end, 20 quality indicators were built for OBD and 6 for PAD. Reasons for discarding CR were a controversial intervention (1 case in OBD), and limited clinical relevance (1 in OBD, 2 in PAD). While indicators could be defined for every main intervention in obstetrics, we could not define indicators for important surgical and diagnostic techniques in PAD (e.g. endovascular techniques).
Conclusions: The development of evidence-based indicators is more difficult for some specialties. Challenges arise when the available research has low methodological quality, interventions used in clinical practice are in rapid turnover, there is no sound evidence to support the available interventions, the health condition is infrequent or its management is individualized.
Objectives: To compare the process and results of developing evidence-based healthcare quality indicators in two different clinical specialties, obstetrics & delivery (OBD) and peripheral vascular disease (PAD).
Methods: The OBD and PAD projects followed a similar methodology, described elsewhere. Systematic reviews (SR) were identified through bibliographic searches, and their risk of bias was assessed. Clinical recommendations were built from low risk of bias SR, and their quality of evidence was assessed. Only those CR supported by high quality evidence were used to define indicators. The proposed indicators were assessed to discard those measuring controversial interventions (e.g. unclear benefit-harm balance) or of limited clinical relevance.
Results: There was less available evidence for OBD than for PAD, but such evidence was of higher quality and led to more clinical recommendations (see Table 1). In the end, 20 quality indicators were built for OBD and 6 for PAD. Reasons for discarding CR were a controversial intervention (1 case in OBD), and limited clinical relevance (1 in OBD, 2 in PAD). While indicators could be defined for every main intervention in obstetrics, we could not define indicators for important surgical and diagnostic techniques in PAD (e.g. endovascular techniques).
Conclusions: The development of evidence-based indicators is more difficult for some specialties. Challenges arise when the available research has low methodological quality, interventions used in clinical practice are in rapid turnover, there is no sound evidence to support the available interventions, the health condition is infrequent or its management is individualized.
PDF