Evaluation: Quality in Headache Services
This chapter sets out a multidimensional definition of quality in the context of headache care, along with a related set of quality indicators currently undergoing evaluation. Both were developed for the purposes, inter alia, of guiding implementation of structured headache services in countries that lack them and improving them elsewhere.
The domains of quality, and indicators, relate to structure and process rather than outcomes. Whereas outcome indicators can summarize all aspects of care, they may offer little or no guidance as to what needs improving when deficiencies are revealed. Outcome measures are influenced by many factors, not all dependent on quality of care. Most challengingly, outcome measures, if used to evaluate quality of care, require objective standards, which cannot be set independently of circumstances, setting and patient mix. Quality assured in structure and process is, therefore, the best available guarantor of quality in outcome.
Initial studies are described of implementation of these quality indicators.
KeywordsHeadache disorders Public health Health policy Structured headache services Service organization and delivery Service quality evaluation European Headache Federation Global Campaign against Headache
- 1.Shewhart WA. Statistical method from the viewpoint of quality control. Mineola, NY: Dover Publications; 1939.Google Scholar
- 2.ACT Academy, NHS Improvement Plan, Do, Study, Act (PDSA) cycles and the model for improvement. https://improvement.nhs.uk/documents/2142/plan-do-study-act.pdf.
- 4.Grol R, Baker R, Moss F. Quality improvement research: the science of change in health care. In: Grol R, Baker R, Moss F, editors. Quality improvement research. Understanding the science of change in health care. London: BMJ Books; 2004. p. 1–5.Google Scholar
- 8.Institute of Medicine, Committee to Design a Strategy for Quality Review and Assurance in Medicare. Medicare: a strategy for quality assurance, vol. 1. Washington, DC: National Academies Press; 1990.Google Scholar
- 9.Marshall M, Campbell S. Introduction to quality assessment in general practice. In: Marshall M, Campbell S, Hacker J, Roland M, editors. Quality indicators for general practice. A practical guide to clinical quality indicators for primary care health professionals and managers. London: Royal Society of Medicine Press; 2002. p. 1–6.Google Scholar
- 10.Campbell S, Braspenning J, Hutchinson A, Marshall M. Research methods used in developing and applying quality indicators in primary care. In: Grol R, Baker R, Moss F, editors. Quality improvement research. Understanding the science of change in health care. London: BMJ Books; 2001. p. 6–28.Google Scholar
- 14.Powell A, Davies H, Thomson R. Using routine comparative data to assess the quality of health care: understanding and avoiding common pitfalls. In: Grol R, Baker R, Moss F, editors. Quality improvement research. Understanding the science of change in health care. London: BMJ Books; 2004. p. 29–50.Google Scholar
- 15.Steiner TJ, Lipton RB on behalf of Lifting The Burden: The Global Campaign against Headache. The headache-attributed lost time (HALT) indices: measures of burden for clinical management and population-based research. J Headache Pain. 2018;19:12.Google Scholar
- 16.World Health Organization and Lifting The Burden. Atlas of headache disorders and resources in the world 2011. Geneva: WHO; 2011. http://www.who.int/mental_health/management/atlas_headache_disorders/en/2011.
- 21.O’Flynn N, Ridsdale L. Headache. In: Marshall M, Campbell S, Hacker J, Roland M, editors. Quality indicators in general practice. A practical guide to clinical quality indicators for primary health care professionals and managers. London: Royal Society of Medicine Press; 2002. p. 112–20.Google Scholar
- 24.Lifting The Burden. The Global Campaign against Headache. http://www.l-t-b.org.
- 28.Schramm S, Uluduz D, Gil Gouveia R, Jensen R, Siva A, Uygunoglu U, Gvantsa G, Mania M, Braschinsky M, Filatova E, Latysheva N, Osipova V, Skorobogatykh K, Azimova J, Straube A, Emre Eren O, Martelletti P, De Angelis V, Negro A, Linde M, Hagen K, Radojicic A, Zidverc-Trajkovic J, Podgorac A, Paemeleire K, De Pue A, Lampl C, Steiner TJ, Katsarava Z. Headache service quality: evaluation of quality indicators in 14 specialist-care centres. J Headache Pain. 2016;17:111.CrossRefGoogle Scholar
- 30.Steiner TJ, Buse DC, Al Jumah M, Westergaard ML, Jensen RH, Reed ML, Prilipko L, Mennini FS, Láinez MJA, Ravishankar K, Sakai F, Yu S-Y, Fontebasso M, Al Khathami A, MacGregor EA, Antonaci F, Tassorelli C, Lipton RB on behalf of Lifting The Burden: The Global Campaign against Headache. The headache under-response to treatment (HURT) questionnaire, an outcome measure to guide follow-up in primary care: development, psychometric evaluation and assessment of utility. J Headache Pain. 2018;19:15.Google Scholar