An explicit quality indicator set for measurement of quality of care in patients with cirrhosis.
OBJECTIVE
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.
Kanwal
Fasiha
F
Saint Louis Veterans Administration (VA), Saint Louis University School of Medicine, Saint Louis, Missouri 63141, USA. fkanwal@yahoo.com
Kramer
Jennifer
J
Asch
Steven M
SM
El-Serag
Hashem
H
Spiegel
Brennan M R
BM
Edmundowicz
Steven
S
Sanyal
Arun J
AJ
Dominitz
Jason A
JA
McQuaid
Kenneth R
KR
Martin
Paul
P
Keeffe
Emmet B
EB
Friedman
Lawrence S
LS
Ho
Samuel B
SB
Durazo
Francisco
F
Bacon
Bruce R
BR
D006302:Health Services Research / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000628:therapy*; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000592:standards*; D016896:Treatment Outcome