Measuring quality of care in patients with nonvariceal upper gastrointestinal hemorrhage: development of an explicit quality indicator set.
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.
Kanwal
Fasiha
F
Saint Louis Veterans Administration (VA) and Saint Louis University, Saint Louis, Missouri, USA.
Barkun
Alan
A
Gralnek
Ian M
IM
Asch
Steven M
SM
Kuipers
Ernst J
EJ
Bardou
Marc
M
Sung
Joseph
J
Enns
Robert
R
Agreus
Lars
L
Armstrong
David
D
Spiegel
Brennan M R
BM
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