Quality in the provision of headache care. 1: systematic review of the literature and commentary

Abstract

Widely accepted quality indicators for headache care would provide a basis not only for assessment of care but also, and more importantly, for its improvement. The objective of the study was to identify and summarize existing information on such indicators: specifically, did indicators exist, how had they been developed, what aspects of headache care did they relate to and how and with what utility were they being used? A systematic review of the medical literature was performed. A total of 32 articles met criteria for inclusion. We identified 55 existing headache quality indicators of which 37 evaluated processes of headache care. Most were relevant only to specific populations of patients and to care delivered in high-resource settings. Indicators had been used to describe overall quality of headache care at a national level, but not systematically applied to the evaluation and improvement of headache services in other settings. Some studies had evaluated the use of existing disability and quality of life instruments, but their findings had not been incorporated into quality indicators. Existing headache care quality indicators are incomplete and inadequate for purpose. They emphasize processes of care rather than structure or outcomes, and are not widely applicable to different levels and locations of headache care. Furthermore, they do not fully incorporate accepted evidence regarding optimal methods of care. There is a clear need for consensus-based indicators that fully reflect patients’ and public-health priorities. Ideally, these will be valid across cultures and health-care settings.Electronic supplementary materialThe online version of this article (doi:10.1007/s10194-012-0466-1) contains supplementary material, which is available to authorized users.

Headache service quality: evaluation of quality indicators in 14 specialist-care centres

“…Neither waiting time nor time allocated to patients’ visits appeared to influence patient satisfaction. A thorough evaluation of service quality may need to look more closely into the reasons for satisfaction or dissatisfaction of patients: while the original formulation of the quality indicators took patients’ expressed preferences into account [7], there may be intercultural differences. Most patients suffering from headache who receive timely and good-quality health care can expect this care to be effective, restoring quality of life [12], but good quality in health care has not been the automatic result of the marked changes in scope, character and content of headache practice and care that have occurred during the last years.…”

“…As a collaborative group of health-services researchers and headache specialists, we first defined quality in the context of headache care [7], then formulated a set of quality indicators based on this definition that might be applied to headache care across countries, cultures and settings [8]. The ultimate purpose was that inadequacies in headache care worldwide might be recognized and rectified.…”

“…“Good quality headache care achieves accurate diagnosis and individualized management, has appropriate referral pathways, educates patients about their headaches and their management, is convenient and comfortable, satisfies patients, is efficient and equitable, assesses outcomes and is safe” [7]. …”

Evaluation of headache service quality indicators: pilot implementation in two specialist-care centres

“…To address this, so that deficiencies in headache care worldwide might be recognized and rectified, the Global Campaign against Headache [ 1 , 2 ] in collaboration with the European Headache Federation (EHF) brought together a service quality evaluation (SQE) group of health-services researchers and headache specialists. Their first completed task, after a literature review [ 3 ], was to develop a definition of quality, which they conceived as residing in nine separate domains (see Table 1 ):…”

Chuanxiong chadiao powder, a famous Chinese herbal prescription, for headache: A systematic review and meta-analysis

“…In fact, existing headache care quality indicators are incomplete and inadequate for purpose because they emphasize processes of care rather than structure or outcomes, and are not widely applicable to different levels and locations of headache care. 72 Thus, we need to improve and develop effective headache care quality indicators to evaluate disability, quality of life or patients' satisfaction with care. Thirdly, the safety of TCM that are increasingly recommended for various health problems has been concerned by both national health authorities and the general public.…”