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. 2021 Oct;33(10):e14118.
doi: 10.1111/nmo.14118. Epub 2021 Mar 15.

Development of quality indicators for the diagnosis and management of achalasia

Afrin N Kamal  1 , Priya Kathpalia  2 , Fouad Otaki  3 , Albert J Bredenoord  4 , Donald O Castell  5 , John O Clarke  1 , Gary W Falk  6 , Ronnie Fass  7 , C Prakash Gyawali  8 , Peter J Kahrilas  9 , Philip O Katz  10 , David A Katzka  11 , John E Pandolfino  9 , Roberto Penagini  12   13 , Joel E Richter  14 , Sabine Roman  15 , Edoardo Savarino  16 , George Triadafilopoulos  1 , Michael F Vaezi  17 , Marcelo F Vela  18 , David A Leiman  19
Affiliations

Development of quality indicators for the diagnosis and management of achalasia

Afrin N Kamal et al. Neurogastroenterol Motil. 2021 Oct.

Abstract

Background: The management of achalasia has improved due to diagnostic and therapeutic innovations. However, variability in care delivery remains and no established measures defining quality of care for this population exist. We aimed to use formal methodology to establish quality indicators for achalasia patients.

Methods: Quality indicator concepts were identified from the literature, consensus guidelines and clinical experts. Using RAND/University of California, Los Angeles (UCLA) Appropriateness Method, experts in achalasia independently ranked proposed concepts in a two-round modified Delphi process based on 1) importance, 2) scientific acceptability, 3) usability, and 4) feasibility. Highly valid measures required strict agreement (≧ 80% of panelists) in the range of 7-9 for across all four categories.

Key results: There were 17 experts who rated 26 proposed quality indicator topics. In round one, 2 (8%) quality measures were rated valid. In round two, 19 measures were modified based on panel suggestions, and experts rated 10 (53%) of these measures as valid, resulting in a total of 12 quality indicators. Two measures pertained to patient education and five to diagnosis, including discussing treatment options with risk and benefits and using the most recent version of the Chicago Classification to define achalasia phenotypes, respectively. Other indicators pertained to treatment options, such as the use of botulinum toxin for those not considered surgical candidates and management of reflux following achalasia treatment.

Conclusions & inferences: Using a robust methodology, achalasia quality indicators were identified, which can form the basis for establishing quality gaps and generating fully specified quality measures.

Keywords: achalasia; clinical practice; esophageal dysphagia; esophageal motility; quality indicators.

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Conflict of interest statement

CONFLICT OF INTEREST

Afrin N. Kamal: None, Priya Kathpalia: None, Fouad Otaki: None, Albert J Bredenoord: Received speaker and/or consulting fees from Laborie, Diversatek, Medtronic, Donald O. Castell: None reported, John O. Clarke: Consultant for Isothrive, Medtronic, Pfizer, Regeneron/Sanofi; site principal investigator for Ironwood, Impleo Medical, Gary W. Falk: None, Ronnie Fass: Advisor – Medtronic, Speaker – Diversitek, C. Prakash Gyawali: Consulting: Medtronic, Diversatek, Ironwood, Isothrive, Quintiles, Peter J Kahrilas: Consultant/Advisory Boards: Reckitt Benckiser [Reflux disease (Aluminum hydroxide/magnesium carbonate)]; Ironwood [Irritable bowel (Linaclotide)], Philip O. Katz: None, David A. Katzka: Education consulting for Shire and Takeda, Roberto Penagini: None, John E. Pandolfino: Crospon [IP], Medtronic [Speaking, Consulting, Licensing, Grant], Diversatek [Speaking/Consulting/Grant], Takeda [Consulting]. Ironwood [Consulting, Grant], Sabine Roman: Consulting Medtronic, Research support: Medtronic, Diverstak Healthcare, Joel E. Richter: None, Edoardo Savarino: Consultant: Abbvie, Allergan, MSD, Takeda, Sofar, and Janssen, Teaching and speaking: Medtronic, Reckitt-Benckiser, Malesci, and Zambon, George Triadafilopoulos: None, Michael F. Vaezi: Research support Diversatek; Consulting Pathom, Marcelo F. Vela: Medtronic (consulting), Diversatek (research support), Fouad Otaki: None, David A. Leiman: Chair-elect of the American Gastroenterological Association (AGA) Quality Committee (QC). The current manuscript reflects individual work not completed on behalf, or with the endorsement of, the AGA or the QC, which would evaluate any indicators independently. Education consultant, Medtronic.

Figures

FIGURE 1
FIGURE 1
Schematic overview for generating quality indicators and quality measures from literature review, guidelines, and expert input. The current study identified 12 quality indicators that may be further developed as concepts for specified quality measure development.
See this image and copyright information in PMC

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