Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury

J.A. Huijben; E.J.A. Wiegers; N.F. Keizer; A.I.R. Maas; D. Menon; A. Ercole; G. Citerio; F. Lecky; L. Wilson; M.C. Cnossen; S. Polinder; E.W. Steyerberg; M.D. Jagt; H.F. Lingsma; Delphi Panel; M. Aries; R. Badenes; A. Beishuizen; F. Bilotta; A. Chieregato; E. Cingolani; M. Cnossen; M. Coburn; J.P. Coles; M. Delargy; B. Depreitere; H. Flaatten; V. Golyk; E. Grauwmeijer; I. Haitsma; R. Helbok; C. Hoedemaekers; B. Jacobs; K. Jellema; L.O.D. Koskinen; M. Maegele; M.C.M. Delgado; K. Moller; R. Moreno; D. Nelson; A.W. Oldenbeuving; J.F. Payen; J. Pejakovic; G.M. Ribbbers; R. Rossaint; G.G. Schoonman; L.A. Steiner; N. Stocchetti; F. Silvio; R. Takala; O. Tenovuo

doi:10.1186/s13054-019-2377-x

Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury

J.A. Huijben^*, E.J.A. Wiegers, N.F. Keizer, A.I.R. Maas, D. Menon, A. Ercole, G. Citerio, F. Lecky, L. Wilson, M.C. Cnossen, S. Polinder, E.W. Steyerberg, M.D. Jagt, H.F. Lingsma, Delphi Panel, M. Aries, R. Badenes, A. Beishuizen, F. Bilotta, A. ChieregatoE. Cingolani, M. Cnossen, M. Coburn, J.P. Coles, M. Delargy, B. Depreitere, H. Flaatten, V. Golyk, E. Grauwmeijer, I. Haitsma, R. Helbok, C. Hoedemaekers, B. Jacobs, K. Jellema, L.O.D. Koskinen, M. Maegele, M.C.M. Delgado, K. Moller, R. Moreno, D. Nelson, A.W. Oldenbeuving, J.F. Payen, J. Pejakovic, G.M. Ribbbers, R. Rossaint, G.G. Schoonman, L.A. Steiner, N. Stocchetti, F. Silvio, R. Takala, O. Tenovuo

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BackgroundWe aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators.MethodsA preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool.ResultsThe expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N=24, 48%) and neurosurgeons (N=7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N=49, 98%) and indicated routine measurement in registries (N=41, 82%), benchmarking (N=42, 84%), and quality improvement programs (N=41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N=48, 98%).ConclusionsThis Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.

Original language	English
Article number	95
Number of pages	13
Journal	Critical Care
Volume	23
DOIs	https://doi.org/10.1186/s13054-019-2377-x
Publication status	Published - 22 Mar 2019

Keywords

adherence
benchmarking
children
guidelines
hospital-care
intensive care unit
management
neurotrauma effectiveness research
of-care
outcomes
quality indicators
quality of care
trauma registry
traumatic brain injury
validity
Trauma registry
Traumatic brain injury
GUIDELINES
Quality indicators
Intensive care unit
NEUROTRAUMA EFFECTIVENESS RESEARCH
VALIDITY
OF-CARE
MANAGEMENT
BENCHMARKING
Benchmarking
HOSPITAL-CARE
ADHERENCE
CHILDREN
OUTCOMES
Quality of care

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Huijben, J. A., Wiegers, E. J. A., Keizer, N. F., Maas, A. I. R., Menon, D., Ercole, A., Citerio, G., Lecky, F., Wilson, L., Cnossen, M. C., Polinder, S., Steyerberg, E. W., Jagt, M. D., Lingsma, H. F., Delphi Panel, Aries, M., Badenes, R., Beishuizen, A., Bilotta, F., ... Tenovuo, O. (2019). Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury. Critical Care, 23, Article 95. https://doi.org/10.1186/s13054-019-2377-x

@article{71e56f3a3b074a77999dd8e6b4651c8c,

title = "Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury",

abstract = "BackgroundWe aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators.MethodsA preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool.ResultsThe expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N=24, 48%) and neurosurgeons (N=7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N=49, 98%) and indicated routine measurement in registries (N=41, 82%), benchmarking (N=42, 84%), and quality improvement programs (N=41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N=48, 98%).ConclusionsThis Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.",

keywords = "adherence, benchmarking, children, guidelines, hospital-care, intensive care unit, management, neurotrauma effectiveness research, of-care, outcomes, quality indicators, quality of care, trauma registry, traumatic brain injury, validity, Trauma registry, Traumatic brain injury, GUIDELINES, Quality indicators, Intensive care unit, NEUROTRAUMA EFFECTIVENESS RESEARCH, VALIDITY, OF-CARE, MANAGEMENT, BENCHMARKING, Benchmarking, HOSPITAL-CARE, ADHERENCE, CHILDREN, OUTCOMES, Quality of care",

author = "J.A. Huijben and E.J.A. Wiegers and N.F. Keizer and A.I.R. Maas and D. Menon and A. Ercole and G. Citerio and F. Lecky and L. Wilson and M.C. Cnossen and S. Polinder and E.W. Steyerberg and M.D. Jagt and H.F. Lingsma and {Delphi Panel} and M. Aries and R. Badenes and A. Beishuizen and F. Bilotta and A. Chieregato and E. Cingolani and M. Cnossen and M. Coburn and J.P. Coles and M. Delargy and B. Depreitere and H. Flaatten and V. Golyk and E. Grauwmeijer and I. Haitsma and R. Helbok and C. Hoedemaekers and B. Jacobs and K. Jellema and L.O.D. Koskinen and M. Maegele and M.C.M. Delgado and K. Moller and R. Moreno and D. Nelson and A.W. Oldenbeuving and J.F. Payen and J. Pejakovic and G.M. Ribbbers and R. Rossaint and G.G. Schoonman and L.A. Steiner and N. Stocchetti and F. Silvio and R. Takala and O. Tenovuo",

note = "Funding Information: European Commission FP7 Framework Program 602150. The study was part of the CENTER-TBI project, a large collaborative project with the support of the European Commission 7th Framework program (602150). The funder had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. DKM was supported by the National Institute for Health Research (NIHR), UK, through an NIHR Senior Investigator Award and the Cambridge NIHR Biomedical Research Centre. Publisher Copyright: {\textcopyright} The Author(s). 2019.",

year = "2019",

month = mar,

day = "22",

doi = "10.1186/s13054-019-2377-x",

language = "English",

volume = "23",

journal = "Critical Care",

issn = "1364-8535",

publisher = "BioMed Central Ltd",

}

Huijben, JA, Wiegers, EJA, Keizer, NF, Maas, AIR, Menon, D, Ercole, A, Citerio, G, Lecky, F, Wilson, L, Cnossen, MC, Polinder, S, Steyerberg, EW, Jagt, MD, Lingsma, HF, Delphi Panel, Aries, M, Badenes, R, Beishuizen, A, Bilotta, F, Chieregato, A, Cingolani, E, Cnossen, M, Coburn, M, Coles, JP, Delargy, M, Depreitere, B, Flaatten, H, Golyk, V, Grauwmeijer, E, Haitsma, I, Helbok, R, Hoedemaekers, C, Jacobs, B, Jellema, K, Koskinen, LOD, Maegele, M, Delgado, MCM, Moller, K, Moreno, R, Nelson, D, Oldenbeuving, AW, Payen, JF, Pejakovic, J, Ribbbers, GM, Rossaint, R, Schoonman, GG, Steiner, LA, Stocchetti, N, Silvio, F, Takala, R & Tenovuo, O 2019, 'Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury', Critical Care, vol. 23, 95. https://doi.org/10.1186/s13054-019-2377-x

TY - JOUR

T1 - Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury

AU - Huijben, J.A.

AU - Wiegers, E.J.A.

AU - Keizer, N.F.

AU - Maas, A.I.R.

AU - Menon, D.

AU - Ercole, A.

AU - Citerio, G.

AU - Lecky, F.

AU - Wilson, L.

AU - Cnossen, M.C.

AU - Polinder, S.

AU - Steyerberg, E.W.

AU - Jagt, M.D.

AU - Lingsma, H.F.

AU - Delphi Panel

AU - Aries, M.

AU - Badenes, R.

AU - Beishuizen, A.

AU - Bilotta, F.

AU - Chieregato, A.

AU - Cingolani, E.

AU - Cnossen, M.

AU - Coburn, M.

AU - Coles, J.P.

AU - Delargy, M.

AU - Depreitere, B.

AU - Flaatten, H.

AU - Golyk, V.

AU - Grauwmeijer, E.

AU - Haitsma, I.

AU - Helbok, R.

AU - Hoedemaekers, C.

AU - Jacobs, B.

AU - Jellema, K.

AU - Koskinen, L.O.D.

AU - Maegele, M.

AU - Delgado, M.C.M.

AU - Moller, K.

AU - Moreno, R.

AU - Nelson, D.

AU - Oldenbeuving, A.W.

AU - Payen, J.F.

AU - Pejakovic, J.

AU - Ribbbers, G.M.

AU - Rossaint, R.

AU - Schoonman, G.G.

AU - Steiner, L.A.

AU - Stocchetti, N.

AU - Silvio, F.

AU - Takala, R.

AU - Tenovuo, O.

N1 - Funding Information: European Commission FP7 Framework Program 602150. The study was part of the CENTER-TBI project, a large collaborative project with the support of the European Commission 7th Framework program (602150). The funder had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. DKM was supported by the National Institute for Health Research (NIHR), UK, through an NIHR Senior Investigator Award and the Cambridge NIHR Biomedical Research Centre. Publisher Copyright: © The Author(s). 2019.

PY - 2019/3/22

Y1 - 2019/3/22

N2 - BackgroundWe aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators.MethodsA preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool.ResultsThe expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N=24, 48%) and neurosurgeons (N=7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N=49, 98%) and indicated routine measurement in registries (N=41, 82%), benchmarking (N=42, 84%), and quality improvement programs (N=41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N=48, 98%).ConclusionsThis Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.

AB - BackgroundWe aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators.MethodsA preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool.ResultsThe expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N=24, 48%) and neurosurgeons (N=7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N=49, 98%) and indicated routine measurement in registries (N=41, 82%), benchmarking (N=42, 84%), and quality improvement programs (N=41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N=48, 98%).ConclusionsThis Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.

KW - adherence

KW - benchmarking

KW - children

KW - guidelines

KW - hospital-care

KW - intensive care unit

KW - management

KW - neurotrauma effectiveness research

KW - of-care

KW - outcomes

KW - quality indicators

KW - quality of care

KW - trauma registry

KW - traumatic brain injury

KW - validity

KW - Trauma registry

KW - Traumatic brain injury

KW - GUIDELINES

KW - Quality indicators

KW - Intensive care unit

KW - NEUROTRAUMA EFFECTIVENESS RESEARCH

KW - VALIDITY

KW - OF-CARE

KW - MANAGEMENT

KW - BENCHMARKING

KW - Benchmarking

KW - HOSPITAL-CARE

KW - ADHERENCE

KW - CHILDREN

KW - OUTCOMES

KW - Quality of care

U2 - 10.1186/s13054-019-2377-x

DO - 10.1186/s13054-019-2377-x

M3 - Article

SN - 1364-8535

VL - 23

JO - Critical Care

JF - Critical Care

M1 - 95

ER -