Table 3 Methods of implementation of quality indicators
From: Headache service quality: evaluation of quality indicators in 14 specialist-care centres
| Â | Indicator | Measure | Application |
|---|---|---|---|
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) b) Frequency or days/month of symptoms is recorded in patient’s record (yes/no) | Review of relevant fields in records of retrospective (random or consecutive) sample of patients (n = 50) |
 A2 | Diagnosis is according to current ICHD criteria | a) Diagnosis is recorded in patient’s record (yes/no) b) Diagnostic record uses ICHD terminology (yes/no) | |
 A3 | A working diagnosis is made at the first visit | Working diagnosis at first visit is recorded in patient’s record (yes/no) | |
 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) | |
 A5 | Diagnosis is reviewed during later follow-up | Diagnostic review during follow-up is routinely undertaken (yes/no) | Enquiry of doctors |
 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) | Enquiry of service manager and doctors into availability |
Domain B. Individualized management is essential for optimal headache care | |||
 B1 | Waiting-list times for appointments are related to urgency of need | a) A formal triage system exists (yes/no) b) To expedite appointments in cases of perceived urgency (yes/no) | Enquiry of doctors, service manager and appointments administrator |
 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 b) Satisfaction (yes/no) with actual time is recorded by patient in exit questionnaire c) HCPs express overall satisfaction (yes/no) | a/b) Review of questionnaires from prospective consecutive sample of patients (n = 50) c) Enquiry of HCPs |
 B4 | Treatment plans include psychological approaches to therapy when appropriate | Access route to psychological therapies exists and doctors are aware of its availability (yes/no/not applicable) | Enquiry of service manager and doctors into availability |
 B5 | Treatment plans reflect disability assessment | An instrument for disability assessment is available and HCPs are aware of its availability (yes/no) | Enquiry of service manager and doctors into availability |
 B6 | Patients are followed up to ascertain optimal outcome | a) The service permits follow-up as needed (yes/no) b) A follow-up diary and/or calendar is available (yes/no) | Enquiry of service manager and HCPs |
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 and doctors and appointments administrator are aware of its existence (yes/no) | Enquiry of service manager, doctors and appointments administrator into availability |
 C2 | Urgent referral pathway is available when necessary | A usable pathway exists and doctors and appointments administrator are aware of its existence (yes/no) | Enquiry of service manager, doctors and appointments administrator into availability |
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 | a) Information leaflets are available (yes/no) and doctors and appointments administrator are aware of their existence (yes/no) b) Doctors provide patients with information (yes/no) c) Information was understandable (yes/no) d) Amount of information was about right (yes/no) | a) Enquiry of service manager, doctors and appointments administrator into availability b) Review of questionnaires from prospective consecutive sample of patients (n = 50) c/d) Review of questionnaires from prospective consecutive sample of patients (n = 50) |
 D2 | Patients are given appropriate reassurance | Satisfaction (yes/no) with reassurance given is recorded by patient in exit questionnaire | Review of questionnaires from prospective consecutive sample of patients (n = 50) |
Domain E. Convenience and comfort are part of optimal headache care | |||
 E1 | The service environment is clean and comfortable | a) Satisfaction (yes/no) with cleanliness and comfort is recorded by patient in exit questionnaire b) HCPs are satisfied with cleanliness and comfort (yes/no) | a) Review of questionnaires from prospective consecutive sample of patients (n = 50) b) Enquiry of HCPs |
 E2 | The service is welcoming | Satisfaction (yes/no) with welcome is recorded by patient in exit questionnaire | Review of questionnaires from prospective consecutive sample of patients (n = 50) |
 E3 | Waiting times in the clinic are acceptable | a) Actual waiting time (minutes) per visit is recorded by patient in exit questionnaire b) Satisfaction (yes/no) with waiting time is recorded by patient in exit questionnaire c) HCPs are satisfied with waiting times (yes/no) | a/b) Review of questionnaires from prospective consecutive sample of patients (n = 50) c) Enquiry of HCPs |
Domain F. Achieving patient satisfaction is part of optimal headache care | |||
 F1 | Patients are satisfied with their management | Satisfaction (yes/no) with overall management is recorded by patient in exit questionnaire | Review of questionnaires from prospective consecutive sample of patients (n = 50) |
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) | Enquiry of service manager |
 G2 | Costs of the service are measured as part of a cost-effectiveness policy | A record of input costs exists (yes/no) | Enquiry of service manager |
 G3 | There is equal access to headache services for all who need it | A policy to ensure equal access exists (yes/no) | Enquiry of service manager and HCPs |
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) | An outcome measure (HURT or similar) is available and HCPs are aware of its existence (yes/no) | Enquiry of service manager and HCPs |
 H2 | Outcome measures are based on self-reported disability burden | An outcome measure (HALT or similar) is available and HCPs are aware of its existence (yes/no) | |
 H3 | Outcome measures are based on self-reported quality of life | An outcome measure (WHOQoL or similar) is available and HCPs are aware of its existence (yes/no) | |
Domain I. Optimal headache care is safe | |||
 I1 | Systems are in place to be aware of serious adverse eventsa | A system or protocol exists and HCP are aware of its existence (yes/no) | Enquiry of service manager and HCPs |