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Quality of Care Indicators in Patients with Acute Pancreatitis

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Abstract

Background

Acute pancreatitis (AP) is a common and expensive condition. Improving quality of care in AP is vital to minimizing cost and improving patient outcomes. However, there has been little work accomplished toward developing and validating explicit quality indicators (QIs) in AP.

Aims

To define quality of care in patients with AP by developing explicit QIs using standardized techniques.

Methods

We used the UCLA/RAND Delphi panel approach to combine a comprehensive literature review with the collective judgment of experts to identify a defined set of process measures for AP.

Results

We produced 164 candidate QIs after a comprehensive literature review. After Delphi review, 75 had a median rating ≥ 7. We excluded 11 QIs where the disagreement index exceeded 1.0 and combined indicators overlapping in content to produce a final list of 22 QIs. Overall, 8 QIs related to diagnosis, prevention, or determination of etiology, 2 QIs focused on determination of severity, 3 QIs captured fluid resuscitation, 2 QIs measured nutrition, 1 QI use of antibiotics, and 6 QIs captured endoscopic or surgical management.

Conclusions

We have developed 22 QIs spanning the spectrum of AP management including diagnosis, risk stratification, and pharmacological and endoscopic therapy. These QIs will facilitate future quality improvement by practitioners and organizations who treat patients with AP and further identify areas that are amenable to improvement to enhance patient care. We anticipate that this QI set will represent the first step in determining a framework for demonstrating value in the care of patients with AP.

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Abbreviations

AP:

Acute pancreatitis

Apache:

Acute Physiology and Chronic Health Examination

ACG:

American College of Gastroenterology

AGA:

American Gastroenterological Association

APA:

American Pancreatic Association

ASGE:

American Society for Gastrointestinal Endoscopy

BISAP:

Bedside index for severity in acute pancreatitis

BUN:

Blood urea nitrogen

CRP:

C-reactive protein

CECT:

Contrast-enhanced CT

Cr:

Creatinine

DI:

Disagreement index

EMR:

Electronic medical records

ERCP:

Endoscopic retrograde cholangiopancreatography

HCT:

Hematocrit

IAP:

International Association of Pancreatology

PN:

Parenteral nutrition

PEP:

Post-ERCP pancreatitis

QIs:

Quality indicators

SIRS:

Systemic inflammatory response syndrome

WON:

Walled-off necrosis

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Author notes

  1. Gyanprakash Ketwaroo, Robert Jay Sealock: Co-first authors.

Authors and Affiliations

  1. Department of Medicine, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, 77030, USA

    Gyanprakash Ketwaroo & Fasiha Kanwal

  2. Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Gyanprakash Ketwaroo, Robert Jay Sealock, Mohamed Othman & Fasiha Kanwal

  3. Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Steven Freedman & Sunil Sheth

  4. Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Phil A. Hart

  5. Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA, USA

    Wahid Wassef

  6. Brigham and Women’s Hospital, Boston, MA, USA

    Peter Banks

  7. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Santhi Swaroop Vege

  8. Dartmouth Hitchcock Medical Center, Lebanon, NH, USA

    Timothy Gardner

  9. Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Dhiraj Yadav

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  1. Gyanprakash Ketwaroo
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Contributions

Gyanprakash Ketwaroo MD involved in study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis. Robert Jay Sealock MD took part in study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis. Steven Freedman MD PhD contributed to acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Phil A. Hart MD took part in acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Mohamed Othman MD involved in acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Wahid Wassef MD took part in acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Peter Banks MD contributed to acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Santhi Swaroop Vege MD contributed to acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Timothy Gardner MD MS involved in acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Dhiraj Yadav MD contributed to acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Sunil Sheth MD involved in acquisition of data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Fasiha Kanwal MD, MSHS took part in study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis.

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Ketwaroo, G., Sealock, R.J., Freedman, S. et al. Quality of Care Indicators in Patients with Acute Pancreatitis. Dig Dis Sci 64, 2514–2526 (2019). https://doi.org/10.1007/s10620-019-05674-8

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