Table 2 Methods and outcomes of implementation of quality indicators in each centre
Indicator | Measure | Means of enquiry | Evaluators by centre (percentages are of positive responses) | ||
|---|---|---|---|---|---|
Essen | Lisbon | ||||
Domain A. Accurate diagnosis is essential for optimal headache care | |||||
A1 | Patients are asked about the temporal profile of their headaches | a) Duration of presenting complaint is recorded in patient’s record (yes/no) | patients’ records | 99 % | 100 % |
A2 | Diagnosis is according to current ICHD criteria | a) Diagnosis is recorded in patient’s record (yes/no) | patients’ records | 100 % | 100 % |
b) Diagnostic record uses ICHD terminology (yes/no) | patients’ records | 100 % | 92 % | ||
A3 | A working diagnosis is made at the first visit | Working diagnosis at first visit is recorded in patient’s record (yes/no) | patients’ records | 100 % | 92 % |
A4 | A definitive diagnosis is made at first or subsequent visit | Definitive diagnosis is recorded in patient’s record or, if not, an appointment for review has been given (yes/no) | patients’ records | 98 % | 92 % |
A5 | Diagnosis is reviewed during later follow-up | Diagnostic review during follow-up is routinely undertaken (yes/no) | doctors’ questionnaire | 100 % | 100 % |
A6 | Diaries are used to support or confirm diagnosis | The service has a diagnostic diary available, and doctors are aware of its availability (yes/no) | doctors’ questionnaire | 100 % | 100 % |
Domain B. Individualized management is essential for optimal headache care | |||||
B1 | Waiting-list times for appointments are related to urgency of need | a) Waiting-list times are recorded in database (yes/no) | patients’ records | 0 % | 0 % |
b) A formal triage system exists to expedite appointments in cases of perceived urgency (yes/no) | doctors’ questionnaire | yes | yes | ||
B2 | Sufficient time is allocated to each visit for the purpose of good management | a) Actual time (minutes) per visit is recorded by patient in exit questionnaire: 1st visits | patients’ questionnaire | 46 ± 30 | 25 ± 7 |
follow up visits | 27 ± 30 | 24 ± 9 | |||
b) Patient is satisfieda with actual time (yes/not yes) | patients’ questionnaire | 100 % | 92 % | ||
c) Health-care providers express overall satisfaction (yes/no) | patients’ questionnaire | 83 % | 100 % | ||
doctors’ and other HCPs’ questionnaires | |||||
B3 | Patients are asked about the temporal profile of their headaches | Frequency (or days/month) of symptoms is recorded in patient’s record (yes/no) | patients’ records | 100 % | 100 % |
B4 | Treatment plans follow evidence-based guidelines, reflecting diagnosis | Prescribed drugs (names, doses and quantities) are recorded in patient’s record | patients’ records | 100 % | 96 % |
B5 | Treatment plans include psychological approaches to therapy when appropriate | a) Access route to psychological therapies exists (yes/no) | doctors’ questionnaire | yes | yes |
b) Utilisation is recorded in patient’s record | patients’ records | 100 % | 32 % | ||
B6 | Treatment plans reflect disability assessment | a) An instrument for disability assessment is available (yes/no) and is appropriate in the setting (yes/no) | doctors’ questionnaire | yes | yes |
yes | yes | ||||
b) Disability is recorded in patient’s record (yes/no) | patients’ records | 0 % | 100 % | ||
B7 | Patients are followed up to ascertain optimal outcome | a) Follow-up appointment dates appear in central service records | central service records | 36 % | 32 % |
b) A follow-up diary and/or calendar is available (yes/no) | doctors’ questionnaire | yes | yes | ||
Domain C. Appropriate referral pathways are essential for optimal headache care | |||||
C1 | Referral pathway is available from primary to specialist care | A usable pathway exists (yes/no) | doctors’ questionnaire | yes | yes |
C2 | Urgent referral pathway is available when necessary | A usable pathway exists (yes/no) | doctors’ questionnaire | yes | yes |
Domain D. Education of patients about their headaches and their management is essential for optimal headache care | |||||
D1 | Patients are given the information they need to understand their headache and its management | Patient is satisfieda with information given (yes/not yes) | patients’ questionnaire | 99 % | 92 % |
D2 | Patients are given appropriate reassurance | Patient is satisfieda with reassurance given (yes/not yes) | patients’ questionnaire | 100 % | 94 % |
Domain E. Convenience and comfort are part of optimal headache care | |||||
E1 | The service environment is clean and comfortable | a) Patient is satisfieda with cleanliness and comfort (yes/not yes) | patients’ questionnaire | 98 % | 94 % |
b) Health-care providers are satisfied with cleanliness and comfort (yes/no) | doctors’ and other HCPs’ questionnaires | 67 % | 60 % | ||
E2 | The service is welcoming | Patient is satisfieda with welcome (yes/not yes) | patients’ questionnaire | 100 % | 94 % |
E3 | Waiting times in the clinic are acceptable | a) Waiting time (minutes) is recorded by patient in exit questionnaire | patients’ questionnaire | 20 ± 18 | 23 ± 23 |
b) Patient is satisfieda with waiting time (yes/not yes) | patients’ questionnaire | 88 % | 78 % | ||
c) Health-care providers are satisfied with waiting times (yes/no) | doctors’ and other HCPs’ questionnaires | 100 % | 60 % | ||
Domain F. Achieving patient satisfaction is part of optimal headache care | |||||
F1 | Patients are satisfied with their management | Patient is satisfieda with overall management (yes/not yes) | patients’ questionnaire | 96 % | 74 % |
Domain G. Optimal headache care is efficient and equitable | |||||
G1 | Procedures are followed to ensure resources are not wasted | A protocol to limit wastage exists (yes/no) | doctors’ questionnaire | no | no |
G2 | Costs of the service are measured as part of a cost-effectiveness policy | A record of input costs exists (yes/no) | doctors’ questionnaire | yes | yes |
G3 | There is equal access to headache services for all who need it | A policy to ensure equal access exists (yes/no) | doctors’ questionnaire | no | no |
Domain H. Outcome assessment is essential in optimal headache care | |||||
H1 | Outcome measures are based on self-reported symptom burden (headache frequency, duration and intensity) | a) An outcome measure (HURT or similar) is available (yes/no) | doctors’ questionnaire | yes | yes |
b) Outcomes according to this measure are recorded in patient’s record (yes/no/not applicable) | patients’ records | 0 % | 68 % | ||
H2 | Outcome measures are based on self-reported disability burden | a) An outcome measure (HALT or similar) is available (yes/no) | doctors’ questionnaire | no | yes |
b) Outcomes according to this measure are recorded in patient’s record (yes/no/not applicable) | patients’ records | na | 68 % | ||
H3 | Outcome measures are based on self-reported quality of life | a) An outcome measure (WHOQoL or similar) is available (yes/no) | doctors’ questionnaire | no | no |
b) Outcomes according to this measure are recorded in patient’s record (yes/no/not applicable) | patients’ records | na | na | ||
Domain I. Optimal headache care is safe | |||||
I1 | Patients are not over-treatedb | Prescribed drugs (names, doses and quantities) are recorded in patient’s record (yes/no/not applicable) | patients’ records | 100 % | 100 % |
I2 | Systems are in place to be aware of serious adverse eventsc | a) Serious adverse events are recorded | patients’ records, central service records | none | none |
b) A protocol exists for reporting serious adverse events (yes/no) | doctors’ questionnaire | no | yes | ||