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.

, , , , , , , , , , , ,
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., Gralnek, I., Asch, S., Kuipers, E., Bardou, M., … Spiegel, B. (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