Development of a Set of Lupus-Specific, Ambulatory Care-Sensitive, Potentially Preventable Adverse Conditions: A Delphi Consensus Study
Development of a Set of Lupus-Specific, Ambulatory Care-Sensitive, Potentially Preventable Adverse Conditions: A Delphi Consensus Study
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DOI：
10.1002/acr.24095
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发表时间：
2021-01-01
影响因子：
4.7
通讯作者：
Costenbader, Karen H.
中科院分区：
文献类型：
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作者：
Feldman, Candace H.;Speyer, Cameron;Costenbader, Karen H.
目的系统性红斑狼疮（SLE）患者是感染、SLE相关并发症和药物相关并发症的高危人群。本研究进行了定义一组SLE特异性的不良后果，可以预防，或其并发症最小化，如果及时，有效的门诊护理已收到.Methods我们使用了一个修改后的德尔菲过程开始的文献综述和关键知情人访谈，以选择初始SLE特异性的潜在可预防的条件。我们组建了一个由来自8个亚专业的16名美国国家认可的专家组成的小组。在RAND-UCLA适当性方法的指导下，我们进行了两轮调查，并进行了受控反馈和互动网络研讨会，以就一组SLE特定不良状况在人群水平上的可预防性和重要性达成共识。在最后一轮，小组成员认可的潜在的可预防的conditions.Results三十五个潜在的条件最初提出了62个条件，最终被认为是在德尔菲过程中。两轮调查的回复率均为100%，网络研讨会的回复率为88%，最终批准的回复率为94%。符合共识的25种SLE特异性疾病在人群水平上可能是可预防的，并且是重要的，分为4类：疫苗可预防的疾病（6种情况），药物相关并发症（8种情况），生殖健康相关并发症（6个条件），SLE相关并发症结论我们就SLE患者的一系列不良结局达成了共识，如果患者接受高质量的门诊护理，这些不良结局可能是可以预防的。可以在卫生系统一级对这一系列结果进行研究，以确定如何以最佳方式分配资源和提高质量，减少可避免的结果和高危人群之间的差距。
Objective Individuals with systemic lupus erythematosus (SLE) are at high risk for infections and SLE- and medication-related complications. The present study was undertaken to define a set of SLE-specific adverse outcomes that could be prevented, or their complications minimized, if timely, effective ambulatory care had been received.Methods We used a modified Delphi process beginning with a literature review and key informant interviews to select initial SLE-specific potentially preventable conditions. We assembled a panel of 16 nationally recognized US-based experts from 8 subspecialties. Guided by the RAND-UCLA Appropriateness Method, we held 2 survey rounds with controlled feedback and an interactive webinar to reach consensus regarding preventability and importance on a population level for a set of SLE-specific adverse conditions. In a final round, the panelists endorsed the potentially preventable conditions.Results Thirty-five potential conditions were initially proposed; 62 conditions were ultimately considered during the Delphi process. The response rate was 100% for both survey rounds, 88% for the webinar, and 94% for final approval. The 25 SLE-specific conditions meeting consensus as potentially preventable and important on a population level fell into 4 categories: vaccine-preventable illnesses (6 conditions), medication-related complications (8 conditions), reproductive health-related complications (6 conditions), and SLE-related complications (5 conditions).Conclusion We reached consensus on a diverse set of adverse outcomes relevant to SLE patients that may be preventable if patients receive high-quality ambulatory care. This set of outcomes may be studied at the health system level to determine how to best allocate resources and improve quality to reduce avoidable outcomes and disparities among those at highest risk.