Lee Douglas S, Tran Chau, Flintoft Virginia, Grant F Curry, Liu Peter P, Tu Jack V
University of Toronto, Toronto, Canada.
Can J Cardiol. 2003 Mar 31;19(4):357-64.
Quality indicators are measurement tools for assessing the structure, processes and outcomes of care. Although quality indicators have been developed in other countries, Canadian cardiovascular disease indicators do not exist.
To develop quality indicators for measuring and improving congestive heart failure (CHF) care in Canada.
An 11-member multidisciplinary national expert panel was selected from nominees from national medical organizations. Potential quality indicators were identified by a detailed search of published guidelines, randomized trials and outcomes studies. A two-step modified Delphi process was employed with an initial screening round of indicator ratings, followed by a national quality indicator panel meeting, where definitions of the indicators were developed using consensus methods. Indicators were designed to be measurable, using retrospective chart review and linking existing administrative databases.
The case definition criterion was developed based on a discharge diagnosis of CHF (International Classification of Diseases, 9th revision [ICD-9] code 428.x), with diagnostic confirmation using clinical criteria. In total, 29 indicators and five test indicators were recommended. Process indicators included prescription for angiotensin-converting enzyme inhibitors, beta-blockers or warfarin (for atrial fibrillation) at hospital discharge. Nonpharmacological in hospital process indicators included evaluation of left ventricular function, weight measurement and selected patient education counselling instructions. Process indicators in the ambulatory setting included prescription and adherence to drug therapies and physician follow-up. Outcome indicators included mortality, readmissions and emergency visits.
A set of Canadian quality indicators for CHF care encompassing organizational attributes, pharmacotherapy, investigations, counselling, continuity of care and disease outcomes has been developed. These quality indicators will serve as a foundation for future studies evaluating the quality of CHF care in Canada.
质量指标是用于评估医疗结构、过程和结果的测量工具。尽管其他国家已制定了质量指标，但加拿大尚无心血管疾病指标。
制定用于衡量和改善加拿大充血性心力衰竭（CHF）护理的质量指标。
从国家医学组织的提名者中选出一个由11名成员组成的多学科国家专家小组。通过详细检索已发表的指南、随机试验和结果研究来确定潜在的质量指标。采用两步改进的德尔菲法，首先进行指标评级的初步筛选轮，随后召开国家质量指标小组会议，在会上使用共识方法制定指标的定义。指标设计为可测量的，采用回顾性病历审查并链接现有的行政数据库。
病例定义标准基于CHF出院诊断（国际疾病分类第九版[ICD-9]代码428.x）制定，并使用临床标准进行诊断确认。总共推荐了29项指标和5项测试指标。过程指标包括出院时开具血管紧张素转换酶抑制剂、β受体阻滞剂或华法林（用于心房颤动）的处方。住院期间的非药物过程指标包括左心室功能评估、体重测量和选定的患者教育咨询指导。门诊环境中的过程指标包括药物治疗的处方和依从性以及医生随访。结果指标包括死亡率、再入院率和急诊就诊率。
已制定了一套涵盖组织属性、药物治疗、检查、咨询、护理连续性和疾病结果的加拿大CHF护理质量指标。这些质量指标将为未来评估加拿大CHF护理质量的研究奠定基础。
