Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
JAMA Otolaryngol Head Neck Surg. 2022 Mar 1;148(3):209-219. doi: 10.1001/jamaoto.2021.3858.
Primary hyperparathyroidism (pHPT) is a common endocrine disorder with many diagnostic and treatment challenges. Despite high-quality guidelines, care is variable, and there is low adherence to evidence-based treatment pathways.
To develop quality indicators (QIs) to evaluate the diagnosis and treatment of pHPT that could measure, improve, and optimize quality of care and outcomes for patients with this disease.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study used a guideline-based approach to develop QIs that were ranked by a Canadian 9-member expert panel of 3 endocrinologists, 3 otolaryngologists, and 3 endocrine surgeons. Data were analyzed between September 2020 and May 2021.
Candidate indicators (CIs) were extracted from published primary hyperparathyroidism guidelines and summarized with supporting evidence. The 9-member expert panel rated each CI on the validity, reliability, and feasibility of measurement. Final QIs were selected from CIs using the modified RAND-University of California, Los Angeles appropriateness methodology. All panelists were then asked to rank the top 5 QIs for primary, endocrine, and surgical care.
Forty QIs were identified and evaluated by the expert panel. After 2 rounds of evaluations and discussion, a total of 18 QIs were selected as appropriate measures of high-quality care. The top 5 QIs for primary, endocrine, and surgical care were selected following panelist rankings.
This quality improvement study proposes 18 QIs for the diagnosis and management of pHPT. Furthermore, the top 5 QIs applicable to physicians commonly treating pHPT, including general physicians, internists, endocrinologists, otolaryngologists, and surgeons, are included. These QIs not only assess the quality of care to guide the process of improvement, but also can assess the implementation of evidence-based guideline recommendations. Using these indicators in clinical practice and health system registries can improve quality and cost-effectiveness of care for patients with pHPT.
原发性甲状旁腺功能亢进症（pHPT）是一种常见的内分泌疾病，存在许多诊断和治疗挑战。尽管有高质量的指南，但护理质量存在差异，并且对循证治疗路径的依从性较低。
制定质量指标（QIs）来评估 pHPT 的诊断和治疗，以衡量、改善和优化患有这种疾病的患者的护理质量和结果。
设计、设置和参与者：这项质量改进研究使用基于指南的方法制定 QIs，由加拿大的 9 名专家组成，其中包括 3 名内分泌学家、3 名耳鼻喉科医生和 3 名内分泌外科医生。数据于 2020 年 9 月至 2021 年 5 月进行分析。
候选指标（CIs）从已发表的原发性甲状旁腺功能亢进症指南中提取，并附有支持证据进行总结。9 名专家组成员对每个 CI 的有效性、可靠性和可测量性进行了评估。最终 QIs 从 CIs 中使用修改后的 RAND-加州大学洛杉矶分校适宜性方法选择。然后，要求所有小组成员对初级、内分泌和外科护理的前 5 个 QIs 进行排名。
专家小组确定并评估了 40 个 QIs。经过两轮评估和讨论，共选择了 18 个 QIs 作为高质量护理的适当衡量标准。根据小组成员的排名，选择了初级、内分泌和外科护理的前 5 个 QIs。
这项质量改进研究提出了 18 个用于 pHPT 诊断和管理的 QIs。此外，还包括了适用于常见治疗 pHPT 的医生的前 5 个 QIs，包括全科医生、内科医生、内分泌学家、耳鼻喉科医生和外科医生。这些 QIs 不仅评估了护理质量以指导改进过程，还可以评估循证指南建议的实施情况。在临床实践和卫生系统登记处使用这些指标可以提高 pHPT 患者的护理质量和成本效益。
