Objectives: With an increasing emphasis on quality in health care and recognition of inconsistencies in the management of patients with nonvariceal upper gastrointestinal hemorrhage (NVUGIH), it is critical to establish a set of explicit quality indicators (QIs) in NVUGIH. Methods: We conducted a nine-member, multidisciplinary expert panel and followed modified Delphi methods to systematically identify a set of QIs for NVUGIH. The panel performed independent ratings of each candidate QI using a nine-point RAND appropriateness scale, then met in person and re-voted using an iterative process of discussion. The final set comprised QIs with a median RAND Appropriateness Score 7 and no disagreement among experts. Results: Among 116 candidate QIs, the panel rated 26 as valid measures of quality care. The selected QIs cover pre-endoscopy, endoscopy, and post-endoscopy care, including diagnosis, early resuscitation, risk stratification, endoscopic care, Helicobacter pylori management, and proton pump inhibitor therapy. Conclusions: We have developed an explicit set of evidence-based QIs in NVUGIH, providing physicians and institutions with a tool to identify processes amenable to quality improvement. This tool is intended to be applicable in all institutions providing care for NVUGIH patients.

Helicobacter infection, article, gastrointestinal endoscopy, health care quality, human, panel study, patient care, practice guideline, priority journal, proton pump inhibitor, resuscitation, risk assessment, upper gastrointestinal bleeding
dx.doi.org/10.1038/ajg.2010.180, hdl.handle.net/1765/21060
American Journal of Gastroenterology
Erasmus MC: University Medical Center Rotterdam

Kanwal, F, Barkun, A.N, Gralnek, I.M, Asch, S.M, Kuipers, E.J, Bardou, M, … Spiegel, B.M.R. (2010). Measuring quality of care in patients with nonvariceal upper gastrointestinal hemorrhage: Development of an explicit quality indicator set. American Journal of Gastroenterology, 105(8), 1710–1718. doi:10.1038/ajg.2010.180