Development of practice-based quality indicators for the primary care of older adults: a RAND/UCLA Appropriateness Method study protocol

Correia, Rebecca H; Siu, Henry Yu-Hin; Vanstone, Meredith; Jones, Aaron; Gopaul, Aquila; Costa, Andrew P

doi:10.1136/bmjopen-2023-072232

Cited by 1 publication

(14 citation statements)

References 41 publications

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“…We conducted a two-phase RAND/UCLA Appropriateness Method (RAM) study that has been described previously [21]. The Delphi technique and its derivatives, including RAM, have been widely applied in health services research for quality indicator development.…”

Section: Methodsmentioning

confidence: 99%

“…In Canada, family physicians are central to primary care teams and are the most frequent physician providers of medical services to older adults [2]. Although all family physicians must achieve a baseline level of competence to care for elderly patients to be certified for independent practice, there is a range of competence across family physicians [21]. Variability in knowledge and clinical skills of providers may influence quality of care and health outcomes for older patients.…”

Section: Introductionmentioning

confidence: 99%

“…Information systems, such as population-based health administrative data sources, enable the accurate and consistent measurement of indicators by providing access to data at the macro (e.g., healthcare organizations) and micro (e.g., individual patients, providers) levels. Research focused on the development of elderly-focused quality indicators for primary care to-date have not been concerned with operationalizing them [21]. In this context, "operationalize" refers to developing technical specifications to apply, measure, and examine indicators using available data holdings.…”

Section: Introductionmentioning

confidence: 99%

“…In this context, "operationalize" refers to developing technical specifications to apply, measure, and examine indicators using available data holdings. Despite the limitations of using secondary data to make inferences about quality [21], indicators developed without reference to information sources or those that are not feasible to operationalize within a particular context are limited in their utility and capacity to promote change.…”

Section: Introductionmentioning

confidence: 99%

“…We focus on quality indicators that are directly relevant to the clinical activities of physicians (practice-based) and classified as acts of healthcare service delivery (processes). Along with clinical structures and medical outcomes, healthcare service delivery processes are one of three interrelated components comprising the Donabedian model-the dominant quality improvement paradigm that enables evaluations of medical care quality and the performance of health systems [21,24]. Our study is situated within the province of Ontario, Canada to develop technical definitions for each indicator using available administrative data holdings.…”

Section: Introductionmentioning

confidence: 99%

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Primary care quality for older adults: Practice-based quality measures derived from a RAND/UCLA appropriateness method study

Correia,

Dash,

Jones

et al. 2024

PLoS ONE

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We established consensus on practice-based metrics that characterize quality of care for older primary care patients and can be examined using secondary health administrative data. We conducted a two-round RAND/UCLA Appropriateness Method (RAM) study and recruited 10 Canadian clinicians and researchers with expertise relevant to the primary care of elderly patients. Informed by a literature review, the first RAM round evaluated the appropriateness and importance of candidate quality measures in an online questionnaire. Technical definitions were developed for each endorsed indicator to specify how the indicator could be operationalized using health administrative data. In a virtual synchronous meeting, the expert panel offered feedback on the technical specifications for the endorsed indicators. Panelists then completed a second (final) questionnaire to rate each indicator and corresponding technical definition on the same criteria (appropriateness and importance). We used statistical integration to combine technical expert panelists’ judgements and content analysis of open-ended survey responses. Our literature search and internal screening resulted in 61 practice-based quality indicators for rating. We developed technical definitions for indicators endorsed in the first questionnaire (n = 55). Following the virtual synchronous meeting and second questionnaire, we achieved consensus on 12 practice-based quality measures across four Priority Topics in Care of the Elderly. The endorsed indicators provide a framework to characterize practice- and population-level encounters of family physicians delivering care to older patients and will offer insights into the outcomes of their care provision. This study presented a case of soliciting expert feedback to develop measurable practice-based quality indicators that can be examined using administrative data to understand quality of care within population-based data holdings. Future work will refine and operationalize the technical definitions established through this process to examine primary care provision for older adults in a particular context (Ontario, Canada).

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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