A Scoping Review of Process Indicators for Measuring Quality of Care in Glaucoma

Abstract

Précis: There are no standardized process quality indicators (QIs) in glaucoma care. Although they can be inferred from guidelines and trials, they should be designed and standardized to allow better assessment of the quality of care.Purpose: QIs are crucial for assessing the performance of any health care system. To allow efficiency, effectiveness, and patient-centeredness, there is a need for prompt acquisition of up-to-date information. Among the available QIs, process indicators have the highest sensitivity to frequent changes and could better reflect the implementation outcomes of novel ideas and technology. This study aimed to map the available information regarding process QIs in glaucoma care, identify the current development stage of these indicators, and systematically synthesize them. Materials and Methods:We performed a scoping review of 4 electronic bibliographic databases for studies reporting on process QIs in glaucoma. We retrieved 7502 references and created a domain list reflecting the core idea underlying each indicator.Results: We summarized information from 18 documents and listed 20 domains. The most mentioned domains were follow-up, optic nerve head assessment, visual field test, and intraocular pressure. Indicators regarding the quality of life assessment, patient assistance, or presence of written protocols were less frequently mentioned.Conclusions: There are notable variations among process QIs in glaucoma and significant heterogeneity in their descriptions in published studies. Although novel indicators can be inferred from guidelines and trials, they should be designed and standardized for better assessment of performance in health systems to improve their quality.

Nationwide consensus on quality indicators to assess glaucoma care: A modified Delphi approach

“… 40 This fact hindered the possibility of making sound comparisons between the results of this study and of previous ones. QIs that assess performance of a glaucoma unit, through structure, process and outcome indicators, are even more difficult to find, and essentially were represented by two institutional quality standards documents (NICE - National Institute for Health and Care Excellence from United Kingdom 41 and Health Quality Ontario from Canada 42 ) and a recent scoping review 18 that summarized and created a comprehensive list of process QIs domains in glaucoma care. The list of QIs chosen in this current study are in accordance with the list from the cited scoping review and the two quality institutions, denoting the vision towards convergence to uniformity around this subject.…”

“…Most of the studies assessed focused on core outcome measures used in clinical trials. 10 , 15 , 17 Specific studies about performance QIs were scarce 18 (n = 9 studies). Nevertheless, the team members’ knowledge acquired during the development of a recent scoping review 18 about the specific subject of this study turned out to be a good basis for the development of QIs in glaucoma care.…”

“… 10 , 15 , 17 Specific studies about performance QIs were scarce 18 (n = 9 studies). Nevertheless, the team members’ knowledge acquired during the development of a recent scoping review 18 about the specific subject of this study turned out to be a good basis for the development of QIs in glaucoma care. The literature review was supplemented by an assessment of the latest updated international guidelines for glaucoma at the time of the review (from the American Academy of Ophthalmology-AAO (published in 2015), the European Glaucoma Society-EGS (4th edition - 2014), the National Institute for Health and Care Excellence-NICE (published in 2017), the Canadian Ophthalmological Society (published in 2009) and the Finnish Current Care Guideline for Glaucoma (published in 2014)).…”

“…The literature review was supplemented by an assessment of the latest updated international guidelines for glaucoma at the time of the review (from the American Academy of Ophthalmology-AAO (published in 2015), the European Glaucoma Society-EGS (4th edition - 2014), the National Institute for Health and Care Excellence-NICE (published in 2017), the Canadian Ophthalmological Society (published in 2009) and the Finnish Current Care Guideline for Glaucoma (published in 2014)). Information about the main domains to be captured by performance QIs in glaucoma was then retrieved from all the studies and guidelines selected and analyzed (a detailed list of the process domains identified is available in the scoping review 18 ). Finally, the authors (steering group) proposed one or more specific indicators for each domain.…”