title: Selection of key recommendations for quality indicators describing good quality outbreak response.
abstract: BACKGROUND
  The performance of recommended control measures is necessary for quick and uniform infectious disease outbreak control. To assess whether these procedures are performed, a valid set of quality indicators (QIs) is required. The goal of this study was to select a set of key recommendations that can be systematically translated into QIs to measure the quality of infectious disease outbreak response from the perspective of disaster emergency responders and infectious disease control professionals.
  
  
  METHODS
  Applying the Rand modified Delphi procedure, the following steps were taken to systematically select a set of key recommendations: extraction of recommendations from relevant literature; appraisal of the recommendations in terms of relevance through questionnaires to experts; expert meeting to discuss recommendations; prioritization of recommendations through a second questionnaire; and final expert meeting to approve the selected set. Infectious disease physicians and nurses, policymakers and communication experts participated in the expert group (n=48).
  
  
  RESULTS
  In total, 54 national and international publications were systematically searched for recommendations, yielding over 200 recommendations. The Rand modified Delphi procedure resulted in a set of 65 key recommendations. The key recommendations were categorized into 10 domains describing the whole response pathway from outbreak recognition to aftercare.
  
  
  CONCLUSIONS
  This study provides a set of key recommendations that represents 'good quality of response to an infectious disease outbreak'. These key recommendations can be systematically translated into QIs. Organizations and professionals involved in outbreak control can use these QIs to monitor the quality of response to infectious disease outbreaks and to assess in which domains improvement is needed.
authors.affiliation: Radboud university medical center, Radboud Institute for Health Sciences, Academic Collaborative Centre AMPHI, Department of Primary and Community Care, PO box 9101, 6500 HB, Nijmegen, The Netherlands. evelien.belfroid@radboudumc.nl.|Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101, 6500 HB, Nijmegen, The Netherlands. evelien.belfroid@radboudumc.nl.|National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands. evelien.belfroid@radboudumc.nl.
authors.forename: Evelien
authors.initials: E
authors.lastname: Belfroid
authors.affiliation: Radboud university medical center, Radboud Institute for Health Sciences, Academic Collaborative Centre AMPHI, Department of Primary and Community Care, PO box 9101, 6500 HB, Nijmegen, The Netherlands. Jeannine.hautvast@radboudumc.nl.
authors.forename: Jeannine L A
authors.initials: JL
authors.lastname: Hautvast
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101, 6500 HB, Nijmegen, The Netherlands. mirrian.hilbink-smolders@radboudumc.nl.
authors.forename: Mirrian
authors.initials: M
authors.lastname: Hilbink
authors.affiliation: National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands. aura.timen@rivm.nl.
authors.forename: Aura
authors.initials: A
authors.lastname: Timen
authors.affiliation: Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, PO box 9101, 6500 HB, Nijmegen, The Netherlands. marlies.hulscher@radboudumc.nl.
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
mesh_terms: D003697:Delphi Technique; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000592:standards*; D017410:Practice Guidelines as Topic; D019984:Quality Indicators, Health Care / Q000592:standards*