quality indicators in the virtuous circle · dr suleman aktaa. md (hons), mrcp (uk) specialty...
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Dr Suleman AktaaMD (Hons), MRCP (UK)Specialty Trainee in Cardiology Clinical Research FellowLeedsUK
Quality Indicators in the Virtuous Circle
29 January 2020
The degree to which services increase the likelihood of desired outcomes
and are consistent with current knowledge
Quality of Care
Lohr KN (ed.). National Academy Press, 1990
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Quality of Care
Safety
EBM
Patient-centeredness
Timeliness of care
Equity
Efficiency
National Academies Press 2001
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Framework to measure components of the quality of health care
Quality Indicators
Spertus JA, et al. Circulation. 2005;111:1703–12
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Quality Indicator
Scientifically acceptable
Useable
Feasible (measurable)
Important
National Quality Forum
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• Why to measure quality of care
• How to measure quality of care
• Where we can do better
Objectives
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• Why to measure quality of care
• How to measure quality of care
• Where we can do better
Measure to Improve
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T B Dondo et al. BMJ Open 2016;6:e011600
TR: 0.44, 95% CI: 0.41–0.45
Dondo T, et al. Eur Heart J Acute Cardiovasc Care. 2017;6:412–420
• Why to measure quality of care
• How to measure quality of care
• Where we can do better
Quality Indicators
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Schiele F, Gale CP, et al. Eur Heart J Acute Cardiovasc Care. 2017 Feb; 6(1):34-59
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• Proportion of STEMI patients reperfused timely among those eligible
• Numerator: STEMI patients <12 h symptoms-diagnosis, who receive reperfusion therapy
• Denominator: STEMI patients <12 h symptoms-diagnosis eligible for reperfusion
Reperfusion-invasive strategySTEMI
Schiele F, Gale CP, et al. Eur Heart J Acute Cardiovasc Care. 2017 Feb; 6(1):34-59
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QIs Development
Phase 1Identify domains and
dimension of care
Phase 2Literature & CPGs
Review
Phase 3Modified Delphi process
(patient involvement)
Phase 4External validation & feasibility assessment
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Modified from MacLean, et al. N Engl J Med 2018 378:1757-1761
QI selection
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Modified Delphi Process
Inclusion Disagreement Exclusion
Normand SL, et al. Int J Qual Health Care 1998;10:247–260
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Quality Indicators
Mainz J. Int J Qual Health Care 2003; Volume 15, Number 6: pp. 523–530
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• Why to measure quality of care
• How to measure quality of care
• Where we can do better
Quality Indicators
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Maren Batalden et al. BMJ Qual Saf 2016;25:509-517
“What is the matter with you?”
“What matters to you?”
Engaging Patients
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Clinical Research
CPG
QIsrecommended
Clinical Practice
QIsmeasured
EORP
Modified from Califf R, et al. J Am Coll Cardiol. 2002;40:1895–901
Feedback
Education
CollaborationOutcomes
Patient involvement
