Biliary/Pancreas

20 - Acute Pancreatitis Task Force on Quality (APTFQ): Formal Development of Quality Indicators

Tuesday, October 9
8:40 AM - 8:50 AM
Location: Terrace Ballroom 4 (level 400)

Category: Biliary/Pancreas
Elaina Vivian, MPH, CPHQ1, Leslie Cler, MD, FACP, CPE2, Darwin Conwell, MD, MS3, Gregory A. Cote, MD, MSCI4, Richard Dickerman, MD, FACS5, Ashton Ellison, MBChB2, Martin Freeman, MD6, Timothy Gardner, MD, MS7, Samar Habash, MD8, Robert Hawes, MD, FACG9, Prashant Kedia, MD2, Rajesh Krishnamoorthi, MD10, Hellen Oduor, MBChB, MPH11, Stephen J. Pandol, MD12, Georgios Papachristou, MD, PhD13, Sheila Rastegari, DO2, Rathan Reddy, MD2, Andrew Ross, MD10, Amrita Sethi, MD, MSc14, Shyam Varadarajulu, MD9, Santhi Swaroop Vege, MD, FACP, MACG15, Wahid Wassef, MD, MPH, FACG16, C. Mel Wilcox, MD17, David C. Whitcomb, MD, PhD, FACG13, Bechien Wu, MD, MPH18, Dhiraj Yadav, MD, MPH13, Timothy Yen, MD2, Paul R. Tarnasky, MD2
1Methodist Dallas Medical Center, Irving, TX; 2Methodist Dallas Medical Center, Dallas, TX; 3The Ohio State University Wexner Medical Center, Columbus, OH; 4Medical University of South Carolina, Charleston, SC; 5The Liver Institute, Methodist Dallas Medical Center, Dallas, TX; 6University of Minnesota, Minneapolis, MN; 7Dartmouth-Hitchcock Medical Center, Norwich, VT; 8AtlantiCare, Atlantic City, NJ; 9Florida Hospital, Orlando, FL; 10Virginia Mason Medical Center, Seattle, WA; 11Methodist Health System, Dallas, TX; 12Cedars-Sinai Medical Center, Los Angeles, CA; 13University of Pittsburgh Medical Center, Pittsburgh, PA; 14Columbia University Medical Center, New York, NY; 15Mayo Clinic, Rochester, MN; 16University of Massachusetts Memorial Medical Center, Worcester, MA; 17University of Alabama at Birmingham, Birmingham, AL; 18Kaiser Permanente Los Angeles, Los Angeles, CA

Introduction: Detailed recommendations and guidelines for acute pancreatitis (AP) management currently exist. However, guidelines serve a different purpose than quality indicators/measures. Quality indicators (QIs) are developed to measure performance in health care. The goal of the APTFQ was to formally develop QIs for the management of AP patients utilizing a modified version of the Rand/UCLA Appropriateness Methodology (RAM).

Methods: The methodology of this study design is outlined in Figure 1. A multidisciplinary expert panel (gastroenterologists, hospitalists, and surgeons) was convened that included physicians who are acknowledged leaders in their specialty and who represent geographic and practice setting diversity. An in-depth literature review was conducted and a list of proposed QIs was developed. In three rounds (including a face-to-face meeting), panelists reviewed the literature and modified QIs, and rated the QIs on the basis of scientific evidence, bias, interpretability, validity, necessity, and proposed performance targets. See Figure 2 for variable definitions and specifications.

Results: Supporting literature and a list of 71 proposed QIs across 10 AP care domains were sent to the expert panel of 20 to review and independently rate in Round 1 (95% of panelist participated). Based on a Round 2 face-to-face discussion of QIs (75% of panelists attended), 41 QIs were classified as ‘valid’. During Round 3 (90% of panelists participated), panelists rated the 41 valid QIs for necessity and proposed performance thresholds. See Figure 3 for summary results of Rounds 1 through 3. The final classification determined that 40 QIs were both valid and necessary across the AP care domains: Diagnosis (3), Etiology (6), Initial Assessment & Risk Stratification (3), Initial Management (3), ERCP (5), Nutrition (3), Pharmacotherapy (4), Management of Early Complications (5), Surgery (4), and Structure of Care (4).

Discussion: Hospitals and providers receiving and treating patients suffering from AP must ensure that patients receive high-quality care and desired outcomes according to current evidence-based best practices. The modified RAM identifies QIs that have face, construct, and predictive validity. This ACG and physician-led initiative formally developed 40 QIs and proposed performance threshold targets for AP management. These validated QIs provide a dependable quantitative framework for AP quality improvement.

Modified RAM study design used to develop acute pancreatitis quality indicators
Definitions and specifications for validity, necessity, agreement, and performance thresholds
Summary results from Rounds 1 through 3

Disclosures:
Elaina Vivian indicated no relevant financial relationships.
Leslie Cler indicated no relevant financial relationships.
Darwin Conwell indicated no relevant financial relationships.
Gregory Cote indicated no relevant financial relationships.
Richard Dickerman indicated no relevant financial relationships.
Ashton Ellison indicated no relevant financial relationships.
Martin Freeman: Boston scientific – Consultant.
Timothy Gardner indicated no relevant financial relationships.
Samar Habash indicated no relevant financial relationships.
Robert Hawes: Boston Scientific – Consultant. Medtronic – Consultant. Olympus – Consultant.
Prashant Kedia indicated no relevant financial relationships.
Rajesh Krishnamoorthi indicated no relevant financial relationships.
Hellen Oduor indicated no relevant financial relationships.
Stephen Pandol: Akcea – Consultant, Speaker's Bureau.
Georgios Papachristou indicated no relevant financial relationships.
Sheila Rastegari indicated no relevant financial relationships.
Rathan Reddy indicated no relevant financial relationships.
Andrew Ross: Boston Scientific – Consultant.
Amrita Sethi: Boston Scientific – Consultant. Olympus – Consultant.
Shyam Varadarajulu: Boston Scientific, Olympus – Consultant.
Santhi Swaroop Vege: generon – Consultant. hightide – Consultant. takeda – Consultant. uptodate – royalty for chapter.
Wahid Wassef: Abbvie – Consultant. Synteract – Grant/Research Support.
C. Mel Wilcox indicated no relevant financial relationships.
David Whitcomb: Ariel Precision Medicne – Advisory Committee/Board Member, Consultant, Stockholder/Ownership Interest (excluding diversified mutual funds).
Bechien Wu indicated no relevant financial relationships.
Dhiraj Yadav indicated no relevant financial relationships.
Timothy Yen indicated no relevant financial relationships.
Paul Tarnasky indicated no relevant financial relationships.

Rathan Reddy

Gastroenterology & Hepatology Fellow
Methodist Dallas Medical Center
Dallas, Texas

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