Service of Neurology, University Hospital Marqués de Valdecilla and Valdecilla Biomedical Research Institute, Santander, Cantabria, Spain.
Department of Medicine, University of Cantabria, Santander, Cantabria, Spain.
BMJ Open. 2020 Oct 30;10(10):e037190. doi: 10.1136/bmjopen-2020-037190.
Headache is one of the most prevalent and disabling conditions. Its optimal management requires a coordinated and comprehensive response by health systems, but there is still a wide variability that compromises the quality and safety of the care process.
To establish the basis for designing a care pathway for headache patients through identifying key subpathways in the care process and setting out quality and clinical safety standards that contribute to providing comprehensive, adequate and safe healthcare.
A qualitative research study based on the consensus conference technique. Eleven professionals from the Spanish National Health System participated, seven of them with clinical experience in headache and four specialists in healthcare management and quality. First, identification of the key subpathways in the care process for headache, barriers/limitations for optimal quality of care, and quality and safety standards applied in each subpathway. Second, two consecutive consensus rounds were carried out to assess the content of the subpathway level descriptors, until the expert agreement was reached. Third, findings were assessed by 17 external healthcare professionals to determine their understanding, adequacy and usefulness.
Seven key subpathways were identified: (1) primary care, (2) emergency department, (3) neurology department, (4) specialised headache unit, (5) hospitalisation, (6) outpatients and (7) governance and management. Sixty-seventh barriers were identified, the most frequent being related to diagnostic errors (36,1%), resource deficiency (25%), treatment errors (19,4%), lack of health literacy (13,9%) and inadequate communications with care transitions (5,6%). Fifty-nine quality and 31 safety standards were defined. They were related to evaluation (23.3%), patient safety (21.1%), comprehensive care (12.2%), treatment (12.2%), clinical practice guidelines (7.8%), counselling (6.7%), training (4.4%) and patient satisfaction (3.3%).
This proposal incorporates a set of indicators and standards, which can be used to define a pathway for headache patients and determine the levels of quality.
头痛是最常见和最具致残性的疾病之一。其最佳管理需要卫生系统的协调和全面响应，但仍存在很大的差异，这会影响护理过程的质量和安全性。
通过确定护理流程中的关键亚流程，并制定有助于提供全面、充分和安全医疗保健的质量和临床安全标准，为头痛患者的护理路径设计奠定基础。
一项基于共识会议技术的定性研究。来自西班牙国家卫生系统的 11 名专业人员参与了研究，其中 7 人具有头痛临床经验，4 人是医疗保健管理和质量专家。首先，确定头痛护理流程中的关键亚流程、影响最佳护理质量的障碍/限制因素，以及每个亚流程中应用的质量和安全标准。其次，进行了两轮连续的共识会议，以评估亚流程水平描述符的内容，直到专家达成一致。最后，由 17 名外部医疗保健专业人员评估研究结果，以确定其理解程度、充分性和有用性。
确定了 7 个关键亚流程：（1）初级保健，（2）急诊室，（3）神经科，（4）专门的头痛单位，（5）住院，（6）门诊，（7）治理和管理。共确定了 67 个障碍，最常见的是诊断错误（36.1%）、资源不足（25%）、治疗错误（19.4%）、健康素养不足（13.9%）和护理过渡沟通不畅（5.6%）。确定了 59 项质量标准和 31 项安全标准。它们与评估（23.3%）、患者安全（21.1%）、综合护理（12.2%）、治疗（12.2%）、临床实践指南（7.8%）、咨询（6.7%）、培训（4.4%）和患者满意度（3.3%）有关。
本研究提出了一系列指标和标准，可用于为头痛患者定义护理路径，并确定质量水平。
