Development of quality indicators for chronic obstructive pulmonary disease (COPD): A modified RAND appropriateness method

RATIONALE: Quality indicators are evidence-based structures, processes and outcomes of care associated with such a strong benefit that failure to address them reduces likelihood of good health outcomes. OBJECTIVES: Our objective was to use synthesized evidence and diverse expert opinion to create a comprehensive set of evidence-based COPD quality indicators spanning the health care continuum from prevention to outcome. METHODS: COPD quality indicators were developed using a modified RAND Appropriateness Method consisting of a systematic review of the medical literature followed by a Delphi method survey. The review took place in three parts: searching first for existing high quality COPD quality indicators, then for meta-analyses and systematic reviews and, lastly, for individual studies. The Delphi method had an expert panel rate and discussed the indicators in an in-person meeting followed by rounds of electronic surveys until consensus was reached. RESULTS: The systematic review produced 26 highly rated quality indicators, and 10,002 titles for further assessment. Of these, 32 full-text articles provided supporting evidence for 39 additional COPD quality indicators, for 65 in total. After rounds of review by the expert panel, a final list of 33 quality indicators was endorsed by all. CONCLUSIONS: We generated a comprehensive set of 33 evidence-based COPD quality indicators. These can be used to measure current quality of COPD health and healthcare, develop and implement strategies to improve it and otherwise provide a foundation for quality improvement. Before using in other jurisdictions, these made-in-Canada indicators should be validated to ensure they address their unique circumstances.