title: Development of quality measures for the care of patients with gastroesophageal reflux disease.
abstract: OBJECTIVE
  Gastroesophageal reflux disease (GERD) is a common and costly disorder. Symptoms attributed to GERD have a wide spectrum of presentations and complications that have led to complex diagnostic and management algorithms. As such, there is considerable variation in clinical approaches to GERD. In contrast to multiple published guidelines for the management of GERD, there are few validated GERD quality measures. The objective of this study was to use a well-described, formal methodology to develop valid, physician-led quality measures for all aspects of care for patients with GERD.
  
  
  METHODS
  Quality measures were identified from the literature, consensus guidelines, and GERD experts. Eight clinical experts ranked potential measures for validity on the basis of the RAND/University of California, Los Angeles Appropriateness Methodology.
  
  
  RESULTS
  Of the 52 proposed quality measures, 24 were rated as valid, and 1 new measure was developed. These valid measures were related to initial diagnosis and management (9), monitoring (3), further diagnostic testing (4), proton pump inhibitor refractory symptoms (2), symptoms of chest pain (1), erosive esophagitis (3), esophageal stricture or ring (1), and surgical therapy (2). Fifteen of these measures were ranked with the highest validity. Twenty-seven measures were determined to be equivocal; 89% of these were extracted from guidelines that were based on low or moderate level evidence.
  
  
  CONCLUSIONS
  We used RAND/University of California, Los Angeles Appropriateness Methodology to develop quality measures for GERD care. By examining performance on these valid, formally developed quality measures, clinical practices and individual providers can assess their adherence with them and direct quality improvement efforts accordingly.
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: Renahshah@gmail.com.
authors.forename: Rena
authors.initials: R
authors.lastname: Yadlapati
authors.affiliation: Division of Gastroenterology, Hepatology, Nutrition, University of Utah, Salt Lake City, Utah.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gawron
authors.affiliation: Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Karl
authors.initials: K
authors.lastname: Bilimoria
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas Southwestern Medical Center and the Dallas VA Medical Center, Dallas, Texas.
authors.forename: Kerry B
authors.initials: KB
authors.lastname: Dunbar
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Kahrilas
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania; Division of Gastroenterology, Albert Einstein Medical Center, Philadelphia, Pennsylvania.
authors.forename: Philip
authors.initials: P
authors.lastname: Katz
authors.affiliation: Department of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida Morsani College of Medicine, Tampa, Florida.
authors.forename: Joel
authors.initials: J
authors.lastname: Richter
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York.
authors.forename: Felice
authors.initials: F
authors.lastname: Schnoll-Sussman
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Soper
authors.affiliation: Division of Gastroenterology, Mayo Clinic Arizona, Scottsdale, Arizona.
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Vela
authors.affiliation: Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
mesh_terms: D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000628:therapy*; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D008297:Male; D011787:Quality of Health Care
keywords: Gastroesophageal Reflux Disease (GERD); Measure of Quality of Care; Proton Pump Inhibitor (PPI); RAND/UCLA Appropriateness Methodology (RAM)