Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study
An increasing number of people are living with multiple chronic conditions and it is unclear which quality indicators should be used to guide care for this population. To critically appraise and select the most appropriate set of quality indicators for ambulatory care for older adults with five sele...
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| Veröffentlicht in: | PloS one 2018-12, Vol.13 (12), p.e0208888-e0208888 |
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| creator | Petrosyan, Yelena Barnsley, Jan M Kuluski, Kerry Liu, Barbara Wodchis, Walter P |
| description | An increasing number of people are living with multiple chronic conditions and it is unclear which quality indicators should be used to guide care for this population.
To critically appraise and select the most appropriate set of quality indicators for ambulatory care for older adults with five selected disease combinations.
A two-round web-based Delphi process was used to critically appraise and select quality of care indicators for older adults with diabetes and comorbidities. A fifteen-member Canadian expert panel with broad geographical and clinical representation participated in this study. The panel evaluated process indicators for meaningfulness, potential for improvements in clinical practice, and overall value of inclusion, while outcome indicators were evaluated for importance, modifiability and overall value of inclusion. A 70% agreement threshold was required for high consensus, and 60-69% for moderate consensus as measured on a 5-point Likert type scale.
Twenty high-consensus and nineteen medium-consensus process and outcome indicators were selected for assessing care for older adults with selected disease combinations, including 1) concordant (conditions with a common management plan), 2) discordant (conditions with unrelated management plans), and 3) both types. Panelists reached rapid consensus on quality indicators for care for older adults with concordant comorbid conditions, but not for those with discordant conditions. All selected indicators assess clinical aspects of care. The feedback from the panelists emphasized the importance of developing indicators related to patient-centred aspects of care, including patient self-management, education, patient-physician relationships, and patient's preferences.
The selected quality indicators are not intended to provide a comprehensive tool set for measuring quality of care for older adults with selected disease combinations. The recommended indicators address clinical aspects of care and can be used as a starting point for ambulatory care settings and development of additional quality indicators. |
| doi_str_mv | 10.1371/journal.pone.0208888 |
| format | Article |
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To critically appraise and select the most appropriate set of quality indicators for ambulatory care for older adults with five selected disease combinations.
A two-round web-based Delphi process was used to critically appraise and select quality of care indicators for older adults with diabetes and comorbidities. A fifteen-member Canadian expert panel with broad geographical and clinical representation participated in this study. The panel evaluated process indicators for meaningfulness, potential for improvements in clinical practice, and overall value of inclusion, while outcome indicators were evaluated for importance, modifiability and overall value of inclusion. A 70% agreement threshold was required for high consensus, and 60-69% for moderate consensus as measured on a 5-point Likert type scale.
Twenty high-consensus and nineteen medium-consensus process and outcome indicators were selected for assessing care for older adults with selected disease combinations, including 1) concordant (conditions with a common management plan), 2) discordant (conditions with unrelated management plans), and 3) both types. Panelists reached rapid consensus on quality indicators for care for older adults with concordant comorbid conditions, but not for those with discordant conditions. All selected indicators assess clinical aspects of care. The feedback from the panelists emphasized the importance of developing indicators related to patient-centred aspects of care, including patient self-management, education, patient-physician relationships, and patient's preferences.
The selected quality indicators are not intended to provide a comprehensive tool set for measuring quality of care for older adults with selected disease combinations. The recommended indicators address clinical aspects of care and can be used as a starting point for ambulatory care settings and development of additional quality indicators.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0208888</identifier><identifier>PMID: 30543672</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adults ; Aged ; Ambulatory Care ; Arthritis ; Biology and Life Sciences ; Care and treatment ; Chronic conditions ; Chronic illnesses ; Clinical aspects ; Comorbidity ; Delphi method ; Delphi Technique ; Depressive Disorder - complications ; Depressive Disorder - therapy ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - therapy ; Diabetes therapy ; Diabetics ; Disease control ; Elderly ; Emergency medical services ; Evidence-based medicine ; Health aspects ; Humans ; Hypertension - complications ; Hypertension - therapy ; Indicators ; Management ; Medical care quality ; Medicine and Health Sciences ; Myocardial Ischemia - complications ; Myocardial Ischemia - therapy ; Older people ; Osteoarthritis - complications ; Osteoarthritis - therapy ; Patient care ; Patient education ; People and Places ; Physicians ; Quality control ; Quality Indicators, Health Care ; Quality management</subject><ispartof>PloS one, 2018-12, Vol.13 (12), p.e0208888-e0208888</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Petrosyan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Petrosyan et al 2018 Petrosyan et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-dc3e56e0add57cc2cf4aa5bf710f874ef200fe9fdb8bb29d543cec0a8d6b35543</citedby><cites>FETCH-LOGICAL-c692t-dc3e56e0add57cc2cf4aa5bf710f874ef200fe9fdb8bb29d543cec0a8d6b35543</cites><orcidid>0000-0002-4806-6282 ; 0000-0003-2494-7031</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292587/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6292587/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30543672$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Arrieta, Alejandro</contributor><creatorcontrib>Petrosyan, Yelena</creatorcontrib><creatorcontrib>Barnsley, Jan M</creatorcontrib><creatorcontrib>Kuluski, Kerry</creatorcontrib><creatorcontrib>Liu, Barbara</creatorcontrib><creatorcontrib>Wodchis, Walter P</creatorcontrib><title>Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>An increasing number of people are living with multiple chronic conditions and it is unclear which quality indicators should be used to guide care for this population.
To critically appraise and select the most appropriate set of quality indicators for ambulatory care for older adults with five selected disease combinations.
A two-round web-based Delphi process was used to critically appraise and select quality of care indicators for older adults with diabetes and comorbidities. A fifteen-member Canadian expert panel with broad geographical and clinical representation participated in this study. The panel evaluated process indicators for meaningfulness, potential for improvements in clinical practice, and overall value of inclusion, while outcome indicators were evaluated for importance, modifiability and overall value of inclusion. A 70% agreement threshold was required for high consensus, and 60-69% for moderate consensus as measured on a 5-point Likert type scale.
Twenty high-consensus and nineteen medium-consensus process and outcome indicators were selected for assessing care for older adults with selected disease combinations, including 1) concordant (conditions with a common management plan), 2) discordant (conditions with unrelated management plans), and 3) both types. Panelists reached rapid consensus on quality indicators for care for older adults with concordant comorbid conditions, but not for those with discordant conditions. All selected indicators assess clinical aspects of care. The feedback from the panelists emphasized the importance of developing indicators related to patient-centred aspects of care, including patient self-management, education, patient-physician relationships, and patient's preferences.
The selected quality indicators are not intended to provide a comprehensive tool set for measuring quality of care for older adults with selected disease combinations. The recommended indicators address clinical aspects of care and can be used as a starting point for ambulatory care settings and development of additional quality indicators.</description><subject>Adults</subject><subject>Aged</subject><subject>Ambulatory Care</subject><subject>Arthritis</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Chronic conditions</subject><subject>Chronic illnesses</subject><subject>Clinical aspects</subject><subject>Comorbidity</subject><subject>Delphi method</subject><subject>Delphi Technique</subject><subject>Depressive Disorder - complications</subject><subject>Depressive Disorder - therapy</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - therapy</subject><subject>Diabetes therapy</subject><subject>Diabetics</subject><subject>Disease control</subject><subject>Elderly</subject><subject>Emergency medical services</subject><subject>Evidence-based medicine</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Hypertension - complications</subject><subject>Hypertension - therapy</subject><subject>Indicators</subject><subject>Management</subject><subject>Medical care quality</subject><subject>Medicine and Health Sciences</subject><subject>Myocardial Ischemia - complications</subject><subject>Myocardial Ischemia - therapy</subject><subject>Older people</subject><subject>Osteoarthritis - complications</subject><subject>Osteoarthritis - therapy</subject><subject>Patient care</subject><subject>Patient education</subject><subject>People and Places</subject><subject>Physicians</subject><subject>Quality control</subject><subject>Quality Indicators, Health Care</subject><subject>Quality management</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk1uP1CAUxxujcdfVb2C0iYnRhxkpLZT6YDJZb5NssvH6Sk65zLChZRaoOt9eZqa7mZp9EB6Aw-_84Rw4Wfa0QPOirIs3V27wPdj5xvVqjjBiqd3LToumxDOKUXn_aH6SPQrhCiFSMkofZiclIlVJa3yadV8GsCZuc9NLIyA6H3LtfA5dO9jdcpsL8Gpvc1aqtCMHG0P-28R1Lg20KqqQQy9z4TrnW7ObJK1oXB_e5ov8vbKbtclDHOT2cfZAgw3qyTieZT8-fvh-_nl2cflpeb64mAna4DiTolSEKgRSkloILHQFQFpdF0izulIaI6RVo2XL2hY3MgUjlEDAJG1LklZn2fOD7sa6wMdMBY4LQpqiqkqciOWBkA6u-MabDvyWOzB8b3B-xcFHI6ziNWMNkk1JWUMqXAFDkmGgmoGuoa0hab0bTxvaTkmh-ujBTkSnO71Z85X7xSluMGF1Eng1Cnh3PagQeWeCUNZCr9ywv3dNSVE0KKEv_kHvjm6kVpACML126VyxE-ULQgmpqySVqPkdVOpSdSY9otIm2ScOrycOiYnqT1zBEAJffvv6_-zlzyn78ohdK7BxHZwd9n9oClYHUHgXglf6NskF4ruquMkG31UFH6siuT07fqBbp5syKP8CvUcJMQ</recordid><startdate>20181213</startdate><enddate>20181213</enddate><creator>Petrosyan, Yelena</creator><creator>Barnsley, Jan M</creator><creator>Kuluski, Kerry</creator><creator>Liu, Barbara</creator><creator>Wodchis, Walter P</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-4806-6282</orcidid><orcidid>https://orcid.org/0000-0003-2494-7031</orcidid></search><sort><creationdate>20181213</creationdate><title>Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study</title><author>Petrosyan, Yelena ; Barnsley, Jan M ; Kuluski, Kerry ; Liu, Barbara ; Wodchis, Walter P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-dc3e56e0add57cc2cf4aa5bf710f874ef200fe9fdb8bb29d543cec0a8d6b35543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adults</topic><topic>Aged</topic><topic>Ambulatory Care</topic><topic>Arthritis</topic><topic>Biology and Life Sciences</topic><topic>Care and treatment</topic><topic>Chronic conditions</topic><topic>Chronic illnesses</topic><topic>Clinical aspects</topic><topic>Comorbidity</topic><topic>Delphi method</topic><topic>Delphi Technique</topic><topic>Depressive Disorder - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Petrosyan, Yelena</au><au>Barnsley, Jan M</au><au>Kuluski, Kerry</au><au>Liu, Barbara</au><au>Wodchis, Walter P</au><au>Arrieta, Alejandro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-12-13</date><risdate>2018</risdate><volume>13</volume><issue>12</issue><spage>e0208888</spage><epage>e0208888</epage><pages>e0208888-e0208888</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>An increasing number of people are living with multiple chronic conditions and it is unclear which quality indicators should be used to guide care for this population.
To critically appraise and select the most appropriate set of quality indicators for ambulatory care for older adults with five selected disease combinations.
A two-round web-based Delphi process was used to critically appraise and select quality of care indicators for older adults with diabetes and comorbidities. A fifteen-member Canadian expert panel with broad geographical and clinical representation participated in this study. The panel evaluated process indicators for meaningfulness, potential for improvements in clinical practice, and overall value of inclusion, while outcome indicators were evaluated for importance, modifiability and overall value of inclusion. A 70% agreement threshold was required for high consensus, and 60-69% for moderate consensus as measured on a 5-point Likert type scale.
Twenty high-consensus and nineteen medium-consensus process and outcome indicators were selected for assessing care for older adults with selected disease combinations, including 1) concordant (conditions with a common management plan), 2) discordant (conditions with unrelated management plans), and 3) both types. Panelists reached rapid consensus on quality indicators for care for older adults with concordant comorbid conditions, but not for those with discordant conditions. All selected indicators assess clinical aspects of care. The feedback from the panelists emphasized the importance of developing indicators related to patient-centred aspects of care, including patient self-management, education, patient-physician relationships, and patient's preferences.
The selected quality indicators are not intended to provide a comprehensive tool set for measuring quality of care for older adults with selected disease combinations. The recommended indicators address clinical aspects of care and can be used as a starting point for ambulatory care settings and development of additional quality indicators.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30543672</pmid><doi>10.1371/journal.pone.0208888</doi><tpages>e0208888</tpages><orcidid>https://orcid.org/0000-0002-4806-6282</orcidid><orcidid>https://orcid.org/0000-0003-2494-7031</orcidid><oa>free_for_read</oa></addata></record> |
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| issn | 1932-6203 1932-6203 |
| language | eng |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adults Aged Ambulatory Care Arthritis Biology and Life Sciences Care and treatment Chronic conditions Chronic illnesses Clinical aspects Comorbidity Delphi method Delphi Technique Depressive Disorder - complications Depressive Disorder - therapy Diabetes Diabetes mellitus Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - therapy Diabetes therapy Diabetics Disease control Elderly Emergency medical services Evidence-based medicine Health aspects Humans Hypertension - complications Hypertension - therapy Indicators Management Medical care quality Medicine and Health Sciences Myocardial Ischemia - complications Myocardial Ischemia - therapy Older people Osteoarthritis - complications Osteoarthritis - therapy Patient care Patient education People and Places Physicians Quality control Quality Indicators, Health Care Quality management |
| title | Quality indicators for ambulatory care for older adults with diabetes and comorbid conditions: A Delphi study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-31T12%3A45%3A24IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Quality%20indicators%20for%20ambulatory%20care%20for%20older%20adults%20with%20diabetes%20and%20comorbid%20conditions:%20A%20Delphi%20study&rft.jtitle=PloS%20one&rft.au=Petrosyan,%20Yelena&rft.date=2018-12-13&rft.volume=13&rft.issue=12&rft.spage=e0208888&rft.epage=e0208888&rft.pages=e0208888-e0208888&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0208888&rft_dat=%3Cgale_plos_%3EA565574903%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2155914432&rft_id=info:pmid/30543672&rft_galeid=A565574903&rft_doaj_id=oai_doaj_org_article_78890d936895424a80d82a6f8af7ab7a&rfr_iscdi=true |