Modified Rand Method to Derive Quality Indicators CARDSS with a - - PowerPoint PPT Presentation

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Modified Rand Method to Derive Quality Indicators CARDSS with a - - PowerPoint PPT Presentation

May 25, 2023 272 likes •504 views

Modified Rand Method to Derive Quality Indicators CARDSS with a Case Study in Cardiac Rehabilitation CArdiac Rehabilitation Decision Support System Maritte van Engen-Verheul, Hareld Kemps, Roderik Kraaijenhagen, Nicolette de Keizer, Niels

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SLIDE 1

Mariëtte van Engen-Verheul, Hareld Kemps, Roderik Kraaijenhagen, Nicolette de Keizer, Niels Peek

  • Dept. of Medical Informatics

Academic Medical Center University of Amsterdam

Modified Rand Method to Derive Quality Indicators

with a Case Study in Cardiac Rehabilitation

CARDSS

CArdiac Rehabilitation Decision Support System

MIE 2011, Oslo

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SLIDE 2

guideline implementation systems

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SLIDE 3

the CARDSS project

  • guideline implementation in cardiac

aftercare

  • CDS system based on Dutch cardiac

rehabilitation guidelines

  • was used in ± 40 clinics in the Netherlands

CARDSS

CArdiac Rehabilitation Decision Support System

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SLIDE 4

conclusions from CARDSS RCT

  • system was shown to improve professional adherence

to the guidelines (Goud et al., BMJ 2009;338:b1440)

– “checklist” effect – no need to memorize guidelines – better shared decision making

  • … but there were no changes at the organisational level

– lack of personnel or facilities – poor collaboration with other departments

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SLIDE 5

CARDSS

CARDSS-II

data registry

Audit & Feedback loop Knowledge revision loop

quality indicators

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SLIDE 6

the RAND method (Brook et al., 1986)

Rating procedure (expert panel) Consensus meeting (expert panel) Literature search Preliminary QIs Final set of QIs

Criticisms

  • lack of patient involvement
  • clinical practice guidelines

are not consulted

  • unclear definition of

appropriate care

  • weak reliability of the rating

and consensus procedures

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SLIDE 7
  • ur modifications (1)

Rating procedure (expert panel) Consensus meeting (expert panel) Literature search Preliminary QIs Final set of QIs

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SLIDE 8
  • ur modifications (1)

Rating procedure (expert panel) Consensus meeting (expert panel) Literature search Preliminary QIs Final set of QIs Expert panel

Both professionals and patients

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SLIDE 9
  • ur modifications (2)

Rating procedure (expert panel) Consensus meeting (expert panel) Literature search Preliminary QIs Final set of QIs

Review of guidelines

Expert panel

Preferred structures and procedures

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SLIDE 10
  • ur modifications (3)

Rating procedure (expert panel) Consensus meeting (expert panel) Literature search Preliminary QIs Final set of QIs

Review of guidelines

Expert panel

5-point Likert scale ratings for 1) relationship with patient outcomes 2) possibilities for improvement 3) ease of recording

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SLIDE 11
  • ur modifications (4)

Rating procedure (expert panel) Consensus meeting (expert panel) Literature search Preliminary QIs Final set of QIs

Review of guidelines

Expert panel

Nominal Group Technique

(Dunham, 1998)

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SLIDE 12

application in cardiac rehabilitation

Expert panel

  • 38 professionals (40 invited)
  • 15 patients (30 invited)
  • 92 quality characteristics
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SLIDE 13

application in cardiac rehabilitation

Literature search Expert panel

  • 314 relevent articles
  • 15 quality indicators
  • 24 outcomes measures
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SLIDE 14

application in cardiac rehabilitation

Literature search

Review of guidelines

Expert panel

  • Dutch Guidelines for Cardiac

Rehabilitation

  • 34 procedural requirements
  • 3 structural requirements
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SLIDE 15

application in cardiac rehabilitation

Literature search Preliminary QIs

Review of guidelines

Expert panel

  • 81 potential QIs

for cardiac rehabilitation

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SLIDE 16

application in cardiac rehabilitation

Rating procedure (professionals) Literature search Preliminary QIs

Review of guidelines

Expert panel

  • 60 rated QIs

for cardiac rehabilitation We were unable to include patients in this part of the procedure

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SLIDE 17

application in cardiac rehabilitation

Rating procedure (professionals) Consensus meeting (professionals) Literature search Preliminary QIs Final set of QIs

Review of guidelines

Expert panel

  • 18 QIs for cardiac

rehabilitation

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SLIDE 18

some examples

Structure

  • The rehab teams uses a shared, multidisciplinary

(and preferrably electronic) patient record Processes

  • Fraction of patients for which an individual care plan is

established at the onset of rehabilitation Outcomes

  • Each patient’s improvement in exercise capacity,

measured before and after rehab by bicycle ergometry

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SLIDE 19

discussion

  • the 4 different QI sources were (partially) complementary

to each other

– each source provided candidate QIs that were not provided by the others

  • professionals rarely mentioned outcomes of care
  • it was easy to reach consensus during the meeting

– probably due to the well-structured rating procedure

  • it was not easy to involve patients
  • we did not involve other stakeholders

(e.g. insurance companies)

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SLIDE 20

current & future work

  • CARDSS Online

– web-based quality feedback application – achievable benchmark methodology (Kiefe et al., 2001) – quality improvement plan

  • evaluation study

– cluster RCT – factorial design (decision support / feedback) – ± 20 cardiac rehab clinics

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SLIDE 21
  • different sources of information should be consulted

when defining indicators of care quality

  • there should be clarity (and agreement) about the

definition of quality to achieve consensus

CARDSS

Contact: Niels Peek

  • Dept. of Medical Informatics

Academic Medical Center University of Amsterdam n.b.peek@amc.uva.nl

conclusion