title: Quality indicators for inflammatory bowel disease:  development of process and outcome measures.
abstract: BACKGROUND
  Variation in adherence to management guidelines for inflammatory bowel disease (IBD) suggests variable quality of care. Quality indicators (QIs) can be developed to measure the structure, processes, and outcomes of health care delivery. The RAND/UCLA appropriateness method was used to develop a set of process and outcome QIs to define quality of care for IBD.
  
  
  METHODS
  Guidelines and position papers for IBD published from 2006 to 2011 were reviewed for potential QIs, which were rated by a multidisciplinary panel. Potential process and outcome QIs were discussed at 3 moderated in-person meetings, with pre-meeting and post-meeting confidential electronic voting. Panelists rated the validity and feasibility of QIs on a 1 through 9 scale; disagreement was assessed using a validated index. QIs rated above 8 were selected for the final set.
  
  
  RESULTS
  More than 500 potential process QIs were extracted from guidelines. Following ratings and discussion by the first panel, 35 process QIs were selected for literature review. After the second panel, 10 process QIs were included in the final set. Candidate outcome QIs were then derived from physician, nurse, and patient input and ratings, in addition to outcomes associated with candidate process QIs. None of the top QIs exhibited disagreement.
  
  
  CONCLUSIONS
  A set of QIs for IBD was developed with expert interpretation of the literature and multidisciplinary input. Outcome QIs focused largely on remission and quality of life, whereas process QIs were aimed at therapeutic optimization and patient safety. Evaluation of these QIs in clinical practice is needed to assess the correlation of performance on process QIs with performance on outcome QIs.
authors: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA. melmedg@cshs.org
authors: Gil Y
authors: GY
authors: Melmed
authors: Corey Allan
authors: CA
authors: Siegel
authors: Brennan M
authors: BM
authors: Spiegel
authors: John I
authors: JI
authors: Allen
authors: Robert
authors: R
authors: Cima
authors: Jean-Frederic
authors: JF
authors: Colombel
authors: Themistocles
authors: T
authors: Dassopoulos
authors: Lee A
authors: LA
authors: Denson
authors: Sharon
authors: S
authors: Dudley-Brown
authors: Andrew
authors: A
authors: Garb
authors: Stephen B
authors: SB
authors: Hanauer
authors: Michael D
authors: MD
authors: Kappelman
authors: James D
authors: JD
authors: Lewis
authors: Isabelle
authors: I
authors: Lynch
authors: Amy
authors: A
authors: Moynihan
authors: David T
authors: DT
authors: Rubin
authors: R Balfour
authors: RB
authors: Sartor
authors: Ronald M
authors: RM
authors: Schwartz
authors: Douglas C
authors: DC
authors: Wolf
authors: Thomas A
authors: TA
authors: Ullman
mesh_terms: D006126:Group Processes; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care; D011788:Quality of Life; D014481:United States