Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Am J Rhinol Allergy. 2020 Jul;34(4):519-531. doi: 10.1177/1945892420912158. Epub 2020 Mar 24.
Acute bacterial rhinosinusitis (ABRS) is a highly prevalent disease that is treated by a variety of specialties, including but not limited to, family physicians, emergency physicians, otolaryngology-head and neck surgeons, infectious disease specialists, and allergy and immunologists. Unfortunately, despite high-quality guidelines, variable and substandard care continues to be demonstrated in the treatment of ABRS.
This study aimed to develop ABRS-specific quality indicators (QIs) to evaluate the diagnosis and management that reduces symptoms, improves quality of life, and prevents complications.
A guideline-based approach, proposed by Kötter et al., was used to develop QIs for ABRS. Candidate indicators (CIs) were extracted from 4 guiding documents and evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Each CI and its supporting evidence was summarized and reviewed by an expert panel based on validity, reliability, and feasibility of measurement. Final QIs were selected from CIs utilizing the modified RAND/University of California at Los Angeles appropriateness methodology.
Twenty-nine CIs were identified after literature review and evaluated by our panel. Of these, 5 CIs reached consensus as being appropriate QIs, with 1 requiring additional discussion. After a second round of evaluations, the panel selected 7 QIs as appropriate measures of high-quality care.
This study proposes 7 QIs for the diagnosis and management of patients with ABRS. These QIs can serve multiple purposes, including documenting the quality of care; comparing institutions and providers; prioritizing quality improvement initiatives; supporting accountability, regulation, and accreditation; and determining pay for performance initiatives.
急性细菌性鼻-鼻窦炎（ABRS）是一种高发疾病，可由多种专科医生进行治疗，包括但不限于家庭医生、急诊医生、耳鼻喉科-头颈外科医生、传染病专家以及过敏和免疫学家。不幸的是，尽管有高质量的指南，ABRS 的治疗仍存在治疗方法多样且不规范的情况。
本研究旨在开发 ABRS 特异性质量指标（QIs），以评估能够减轻症状、提高生活质量和预防并发症的诊断和管理方法。
采用 Kötter 等人提出的基于指南的方法，针对 ABRS 开发 QIs。候选指标（CIs）从 4 份指导文件中提取，并使用评估指南研究与评估 II（AGREE II）工具进行评估。每位专家根据有效性、可靠性和测量可行性，对每个 CI 及其支持证据进行总结和审查。最终 QIs 从 CIs 中利用改良的 RAND/加州大学洛杉矶分校适宜性方法进行选择。
文献回顾后确定了 29 个 CIs，并由我们的专家组进行评估。其中，5 个 CIs 被一致认为是合适的 QIs，其中 1 个需要进一步讨论。经过第二轮评估，专家组选择了 7 个 QIs 作为高质量护理的合适衡量标准。
本研究提出了 7 个用于诊断和管理 ABRS 患者的 QIs。这些 QIs 可用于多种目的，包括记录护理质量；比较机构和提供者；确定质量改进计划的优先级；支持问责制、监管和认证；以及确定绩效支付计划。
