A quality indicator set for systemic lupus erythematosus. Arthritis Rheum 61:370-377, 15

Rosalind Russell Medical Research Center for Arthritis, University of California, San Francisco, CA 94143-0920, USA.
Arthritis & Rheumatology (Impact Factor: 7.76). 03/2009; 61(3):370-7. DOI: 10.1002/art.24356
Source: PubMed


To systematically develop a quality indicator (QI) set for systemic lupus erythematosus (SLE).
We used a validated process that combined available scientific evidence and expert consensus to develop a QI set for SLE. We extracted 20 candidate indicators from a systematic literature review of clinical practice guidelines pertaining to SLE. An advisory panel revised and augmented these candidate indicators and, through 2 rounds of voting, arrived at 25 QIs. These QIs advanced to the next phase of the project, in which we employed a modification of the RAND/UCLA Appropriateness Method. A systematic review of the literature was performed for each QI, linking the proposed process of care to potential improved health outcomes. After reviewing this scientific evidence, a second interdisciplinary expert panel convened to discuss the evidence and provide final ratings on the validity and feasibility of each QI.
The final expert panel rated 20 QIs as both valid and feasible. Areas covered included diagnosis, general preventive strategies (e.g., vaccinations, sun avoidance counseling, and screening for cardiovascular disease), osteoporosis prevention and treatment, drug toxicity monitoring, renal disease, and reproductive health.
We employed a rigorous multistep approach with systematic literature reviews and 2 expert panels to develop QIs for SLE. This new set of indicators provides an opportunity to assess health care quality in patients with SLE and represents an initial step toward the important goal of improving care in this patient population.

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Available from: Joann Zell, Sep 27, 2014
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    • "Because immunization and cancer screening recommendations were modified during the study period, we used the guidelines that were applicable when the surveys were administered. For cholesterol monitoring among GOAL participants , we examined recently developed recommendations for SLE, which endorsed annual lipid screening for all SLE patients [23] [24]. Detailed descriptions of recommended services, eligibility criteria, and number of eligible participants for SLE and BRFSS samples are available in the Appendix. "
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    ABSTRACT: Objectives: Systemic lupus erythematosus (SLE) patients are at risk for complications that can be mitigated by appropriate preventive care. We examined the receipt of immunizations, cancer screening, and cardiovascular risk preventive services in a predominantly Black cohort of SLE patients from the Southeast U.S. To identify gaps in primary preventive services (PPS) that might be specific to SLE as opposed to local health system factors, we used as reference a population-based sample from the same area. Methods: A cross-sectional design was used to characterize the percentage of PPS received by 751 SLE patients from Atlanta, GA, and 9040 subjects from the same community, of whom 938 had diabetes. Factors associated with the receipt of PPS were examined with multivariable analysis of variance. Results: Approximately 65% of recommended PPS were provided to the SLE, overall community (OC), and diabetes samples. However, only 22.5%, 45.7%, and 27.6% of SLE, OC, and diabetes subjects, respectively, received all recommended services. Factors associated with a higher percentage of PPS received by SLE patients included older age (63.6% if age ≥65 years, 45.8% if age between 18 and 35 years), having medical insurance (61.1% for insured, 49.7% for uninsured), having a primary care physician (PCP) (59.0% if patient had PCP, 51.8% if patient did not have PCP), and being a non-smoker (61.9% for non-smokers, 49.9% for smokers). Conclusions: Less than one-quarter of SLE patients from a southeast U.S. community received all the recommended services that were studied. Further research is warranted to unravel the barriers that prevent SLE patients from reaching appropriate standards of preventive care.
    Full-text · Article · May 2013 · Seminars in arthritis and rheumatism
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    • "Consequently, it seems logical to generate quality indicators through an explicit and systematic process and this has been our purpose. Other recent studies that have developed indicators in a variety of fields, including performance measures [19], clinical practice guidelines [44-46], or a mixed process of evidence appraisal and expert opinion [47,48], have been published. However, to our knowledge, the present study is unique in its focus on SRs. "
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    ABSTRACT: Background The objective of this research is to generate quality of care indicators from systematic reviews to assess the appropriateness of obstetric care in hospitals. Methods A search for systematic reviews about hospital obstetric interventions, conducted in The Cochrane Library, clinical evidence and practice guidelines, identified 303 reviews. We selected 48 high-quality evidence reviews, which resulted in strong clinical recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The 255 remaining reviews were excluded, mainly due to a lack of strong evidence provided by the studies reviewed. Results A total of 18 indicators were formulated from these clinical recommendations, on antepartum care (8), care during delivery and postpartum (9), and incomplete miscarriage (1). Authors of the systematic reviews and specialists in obstetrics were consulted to refine the formulation of indicators. Conclusions High-quality systematic reviews, whose conclusions clearly claim in favour or against an intervention, can be a source for generating quality indicators of delivery care. To make indicators coherent, the nuances of clinical practice should be considered. Any attempt made to evaluate the extent to which delivery care in hospitals is based on scientific evidence should take the generated indicators into account.
    Full-text · Article · Apr 2013 · Implementation Science
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    • "Of the 48 articles in the final review, 10 papers described methodological approaches to guideline-based QI development in general (referred to as "method papers") [1,7,23-30], and 32 articles [31-62] addressed the guideline-based QI development for a certain clinical topic (referred to as "topic papers"). An additional six papers [10,19,63-66] comprised a detailed description of a method as well as its application for a certain clinical topic (referred to as "method + topic papers"). "
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    ABSTRACT: Quality indicators (QIs) are used in many healthcare settings to measure, compare, and improve quality of care. For the efficient development of high-quality QIs, rigorous, approved, and evidence-based development methods are needed. Clinical practice guidelines are a suitable source to derive QIs from, but no gold standard for guideline-based QI development exists. This review aims to identify, describe, and compare methodological approaches to guideline-based QI development. We systematically searched medical literature databases (Medline, EMBASE, and CINAHL) and grey literature. Two researchers selected publications reporting methodological approaches to guideline-based QI development. In order to describe and compare methodological approaches used in these publications, we extracted detailed information on common steps of guideline-based QI development (topic selection, guideline selection, extraction of recommendations, QI selection, practice test, and implementation) to predesigned extraction tables. From 8,697 hits in the database search and several grey literature documents, we selected 48 relevant references. The studies were of heterogeneous type and quality. We found no randomized controlled trial or other studies comparing the ability of different methodological approaches to guideline-based development to generate high-quality QIs. The relevant publications featured a wide variety of methodological approaches to guideline-based QI development, especially regarding guideline selection and extraction of recommendations. Only a few studies reported patient involvement. Further research is needed to determine which elements of the methodological approaches identified, described, and compared in this review are best suited to constitute a gold standard for guideline-based QI development. For this research, we provide a comprehensive groundwork.
    Full-text · Article · Mar 2012 · Implementation Science
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