title: Measuring quality of care in patients with nonvariceal upper gastrointestinal hemorrhage: development of an explicit quality indicator set.
abstract: OBJECTIVE
  With an increasing emphasis on quality in health care and recognition of inconsistencies in the management of patients with nonvariceal upper gastrointestinal hemorrhage (NVUGIH), it is critical to establish a set of explicit quality indicators (QIs) in NVUGIH.
  
  
  METHODS
  We conducted a nine-member, multidisciplinary expert panel and followed modified Delphi methods to systematically identify a set of QIs for NVUGIH. The panel performed independent ratings of each candidate QI using a nine-point RAND appropriateness scale, then met in person and re-voted using an iterative process of discussion. The final set comprised QIs with a median RAND Appropriateness Score >or=7 and no disagreement among experts.
  
  
  RESULTS
  Among 116 candidate QIs, the panel rated 26 as valid measures of quality care. The selected QIs cover pre-endoscopy, endoscopy, and post-endoscopy care, including diagnosis, early resuscitation, risk stratification, endoscopic care, Helicobacter pylori management, and proton pump inhibitor therapy.
  
  
  CONCLUSIONS
  We have developed an explicit set of evidence-based QIs in NVUGIH, providing physicians and institutions with a tool to identify processes amenable to quality improvement. This tool is intended to be applicable in all institutions providing care for NVUGIH patients.
authors.affiliation: Saint Louis Veterans Administration (VA) and Saint Louis University, Saint Louis, Missouri, USA.
authors.forename: Fasiha
authors.initials: F
authors.lastname: Kanwal
authors.forename: Alan
authors.initials: A
authors.lastname: Barkun
authors.forename: Ian M
authors.initials: IM
authors.lastname: Gralnek
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Marc
authors.initials: M
authors.lastname: Bardou
authors.forename: Joseph
authors.initials: J
authors.lastname: Sung
authors.forename: Robert
authors.initials: R
authors.lastname: Enns
authors.forename: Lars
authors.initials: L
authors.lastname: Agreus
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
authors.forename: Brennan M R
authors.initials: BM
authors.lastname: Spiegel
mesh_terms: D003697:Delphi Technique; D019317:Evidence-Based Medicine; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015995:Prevalence; D019984:Quality Indicators, Health Care; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology