Development of Balanced Whole System Value Measures for Inflammatory Bowel Disease Care in the IBD Qorus Collaborative Using a Modified Delphi Process
Development of Balanced Whole System Value Measures for Inflammatory Bowel Disease Care in the IBD Qorus Collaborative Using a Modified Delphi Process
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DOI：
10.1093/ibd/izab091
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发表时间：
2021-05-25
影响因子：
4.9
通讯作者：
Nelson, Eugene C.
中科院分区：
文献类型：
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作者：
Oliver, Brant J.;Kennedy, Alice M.;Nelson, Eugene C.
背景 IBD Qorus 合作组织旨在减少成人炎症性肠病 (IBD) 社区的变异并提高护理价值。为了评估合作的成功，我们的目标是制定一套平衡的结果衡量标准，反映多利益相关者对 IBD 护理价值的看法。为了实现这一目标，我们使用了临床价值指南针框架，并聘请混合利益相关者团体来执行修改后的德尔菲流程。最终结果是评估 IBD 护理价值的 10 项措施集。方法 修改后的德尔菲流程包括 3 轮迭代盲投票和交互式网络研讨会式讨论。我们为 Delphi 小组招募了 18 名参与者，包括临床医生、研究人员、患者、克罗恩病和结肠炎基金会工作人员以及付款人。参与者首先确定要测量的结构，然后确定测量这些结构的工具。对4个领域的现行措施进行了文献综述和环境扫描，并提出了相关措施，供每个领域的讨论和投票。在整个过程中，参与者被邀请提出额外的措施。结论 修改后的德尔菲流程最终选择了 4 个领域的 10 个价值衡量标准：(1) 患者体验； （二）功能状态； (3)临床状况； (4) 医疗保健费用和利用。我们已经成功完成了 3 阶段修改德尔菲流程，为成人 IBD 护理制定一套平衡的价值衡量标准。该价值衡量标准扩展了之前通过增加护理要素的成本和经验来建立 IBD 护理质量衡量标准的努力。这项工作使 IBD Qorus 能够更好地评估、研究、改进和展示个人、系统和人群层面的价值，并将为相关研究、改进和实施工作提供信息和授权。
Background The IBD Qorus Collaborative aims to reduce variation and increase the value of care for the adult inflammatory bowel disease (IBD) community. To evaluate the success of the collaborative, we aimed to develop a balanced set of outcome measures that reflect a multistakeholder view of value in IBD care. To achieve this, we used the Clinical Value Compass framework and engaged a mixed-stakeholder group to conduct a modified Delphi process. The end result was a 10-measure set to assess the value of IBD care. Method The modified Delphi process included 3 iterative rounds of blinded voting and interactive webinar-style discussion. We recruited 18 participants for the Delphi panel, including clinicians, researchers, patients, Crohn's & Colitis Foundation staff, and payers. Participants first identified constructs to measure, then identified the tools to measure those constructs. A literature review and environmental scan of current measures in 4 domains were performed, and relevant measures were proposed for discussion and voting in each domain. Throughout the process, participants were invited to contribute additional measures. Conclusion The modified Delphi process led to selection of 10 value measures across 4 domains: (1) patient experience; (2) functional status; (3) clinical status; and (4) health care costs and utilization. We have successfully completed a 3-stage modified Delphi process to develop a balanced set of value measures for adult IBD care. The value measure set expands upon prior efforts that have established quality measures for IBD care by adding cost and experience of care elements. This work positions IBD Qorus to better assess, study, improve, and demonstrate value at individual, system, and population levels and will inform and empower related research, improvement, and implementation efforts.