title: Healthcare quality indicators of peripheral artery disease based on systematic reviews.
abstract: OBJECTIVE
  Peripheral artery disease (PAD) is a major health problem whose clinical management includes multiple options regarding risk factor control, diagnosis, and medical and surgical treatment. The aim was to generate indicators based on systematic reviews to evaluate the quality of healthcare provided in PAD.
  
  
  METHODS
  Electronic searches were run for systematic reviews in The Cochrane Library (Issue 6, 2011), MEDLINE, EMBASE, and other databases (up to June 2011). Conclusive systematic reviews of high methodological quality were selected to formulate clinical recommendations. Indicators were derived from clinical recommendations with moderate to very high strength of evidence as assessed by the GRADE system.
  
  
  RESULTS
  From 1,804 reviews initially identified, 29 conclusive and high-quality systematic reviews were selected and nine clinical recommendations were formulated with a moderate to very high strength of recommendation. Six indicators were finally generated: four on pharmacological interventions, antiplatelet agents, naftidrofuryl, cilostazol, and statins; and two lifestyle interventions, exercise and tobacco cessation. No indicators were derived for diagnostic tests or surgical techniques. Most indicators targeted patients with intermittent claudication.
  
  
  CONCLUSIONS
  These quality indicators will help clinicians to assess the appropriateness of healthcare provided in PAD. The development of evidence-based indicators in PAD is limited by the lack of methodological quality of the research in this disease, the inconclusiveness of the evidence on diagnostic and surgical techniques, and the dynamic nature of the vascular diseases field.
authors.affiliation: Vascular and Endovascular Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. Electronic address: sbellmunt@santpau.cat.
authors.forename: S
authors.initials: S
authors.lastname: Bellmunt
authors.affiliation: Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Iberoamerican Cochrane Centre, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Roqué
authors.affiliation: Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Clinical Epidemiology and Public Health Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Osorio
authors.affiliation: Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Iberoamerican Cochrane Centre, Barcelona, Spain.
authors.forename: H
authors.initials: H
authors.lastname: Pardo
authors.affiliation: Vascular and Endovascular Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
authors.forename: J-R
authors.initials: JR
authors.lastname: Escudero
authors.affiliation: Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Iberoamerican Cochrane Centre, Barcelona, Spain; Clinical Epidemiology and Public Health Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Bonfill
mesh_terms: D019317:Evidence-Based Medicine / Q000592:standards; D005081:Exercise Therapy / Q000592:standards; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007383:Intermittent Claudication / Q000175:diagnosis / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D040242:Risk Reduction Behavior; D016540:Smoking Cessation; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents
keywords: Delivery of healthcare; Peripheral vascular disease; Quality indicators