Development of quality indicators for systemic sclerosis patients
Mika Hatano, Nobuyuki Yajima, Utako Kaneko, Shuya Kaneko, Kyoko Tonomura, Ikuko Ueda-Hayakawa, Yasuhito Hamaguchi, Masatoshi Jinnin, Yasushi Kawaguchi, Yoshihito Shima, Hidekata Yasuoka, Masaru Hatano, Masaki Shimizu, Naoki Mugii, Takako Miyamae, Yoshihide AsanoAbstract
Objectives
To develop quality indicators for evaluating and improving care for patients with systemic sclerosis.
Methods
We developed quality indicators using a modified RAND/University of California Los Angeles Appropriateness Method. A systematic literature review identified candidate items from previous systemic sclerosis quality indicator studies and clinical practice guidelines. A multidisciplinary expert panel of 10 physicians specializing in rheumatology, dermatology, pediatrics and cardiology completed two anonymous rating rounds, with item revision after a web-based panel meeting. One physiotherapist and one patient with systemic sclerosis participated as non-voting observers. Items with a median appropriateness score of 7 or higher and strict agreement were retained.
Results
The review identified 86 candidate items from three quality indicator studies and 23 clinical practice guidelines. After first-round rating and discussion, 78 revised items underwent second-round evaluation. Thirty-three indicators met the prespecified selection criteria. The final set covered general management, lung, gastrointestinal, kidney, heart, pulmonary hypertension, vascular, muscle, rehabilitation, and pediatric domains.
Conclusions
We developed a 33-item quality indicator set for systemic sclerosis through a structured consensus process. The indicators may support quality assessment and improvement in Japanese clinical practice.