Objectives Patients with metastatic bone disease (MBD) should receive the same standard of care regardless of which centre they are treated in. The aim was to develop and test a set of quality performance indicators (QPIs) to evaluate care for patients with MBD referred to orthopaedics.
Methods QPIs were adapted from the literature and ranked on feasibility and necessity during a modified RAND/Delphi consensus process. They were then validated and field tested in a retrospective cohort of 108 patients using indicator-specific targets set during consensus.
Results 2568 articles including six guidelines were reviewed. 43 quality objectives were extracted and 40 proceeded to expert consensus. After two rounds, 18 QPIs for MBD care were generated, with the following generating the highest consensus: ‘Patients with high fracture risk should receive urgent assessment’ (combined mean 6.7/7, 95% CI 6.5 to 6.8) and ‘preoperative workup should include full blood tests including group and save’ (combined mean 6.7/7, 95% CI 6.5 to 6.9). In the pilot test, targets were met for 5/18 QPIs (mean 52%, standard deviation 22%). The median deviation from projected target was −14% (interquartile range −11% to −31%, range −74% to 11%). The highest scoring QPI was ‘adults with fractures should have surgery within 7 days’ (target 80%:actual 92%).
Conclusions The published evidence and guidelines were adapted into a set of validated QPIs for MBD care which can be used to evaluate variation in care between centres. These QPIs should be correlated with outcome scores to determine whether they can act as predictors of outcome after surgery.
- chronic conditions
- Clinical decisions
Data availability statement
Data are available on reasonable request. The research team are happy to provide study data on reasonable request, subject to approval by senior author AHRWS.
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Contributors SD: conceptualisation, methodology, formal analysis, writing-original draft preparation JC: validation, writing-reviewing and editing. PH: writing-reviewing and editing. AS: writing-reviewing and editing, supervision. MM: writing-reviewing and editing, supervision. CS: writing-reviewing and editing, supervision. AHRWS: conceptualisation, methodology, writing-reviewing and editing, supervision.
Funding This work was supported by the Royal College of Surgeons of Edinburgh (RCSEd, grant numbers SPPG/19/132 & RTRF/19/009) and AO UK (WE/JC/AOUK Research, 2018).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note The lead author (guarantor) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as originally planned have been explained.
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