Table 2 Methods of implementation of service quality indicators
From: Quality indicators in headache care: an implementation study in six Italian specialist-care centres
Indicator | Measure | Means of enquiry |
|---|---|---|
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 |
A2. Diagnosis is according to current ICHD criteria | a) Diagnosis is recorded in patient’s record (yes/no) | Patients’ records |
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) | Patients’ records |
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 |
A5. Diagnosis is reviewed during later follow-up | Diagnostic review during follow-up is routinely undertaken (yes/no) | Physicians’ questionnaire |
A6. Diaries are used to support or confirm diagnosis | The service has a diagnostic diary available and physicians are aware of its availability (yes/no) | Physicians’ questionnaire |
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 |
b) A formal triage system exists to expedite appointments in cases of perceived urgency (yes/no) | Physicians’ questionnaire | |
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 and follow-up visits | Patients’ questionnaire |
b) Patient is satisfieda with actual time (yes/not yes) | Patients’ questionnaire | |
c) Health-care providers express overall satisfaction (yes/no) | Physicians’ 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 |
B4. Treatment plans follow evidence-based guidelines, reflecting diagnosis | Prescribed drugs (names, doses and quantities) are recorded in patient’s record | Patients’ records |
B5. Treatment plans include psychological approaches to therapy when appropriate | a) Access route to psychological therapies exists (yes/no) | Physicians’ questionnaire |
b) Utilisation is recorded in patient’s record | Patients’ records | |
B6. Treatment plans reflect disability assessment | a) An instrument for disability assessment is available(yes/no) and is appropriate in the setting (yes/no) | Physicians’ questionnaire |
b) Disability is recorded in patient’s record (yes/no) | Patients’ records | |
B7. Patients are followed up to ascertain optimal outcome | a) Follow-up appointment dates appear in central service records (yes/no) | Central service records |
b) A follow-up diary and/or calendar is available (yes/no) | Physician’s questionnaire | |
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) | Physicians’ questionnaire |
C2. Urgent referral pathway is available when necessary | A usable pathway exists (yes/no) | Physicians’ questionnaire |
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 |
D2. Patients are given appropriate reassurance | Patient is satisfieda with information given (yes/not yes) | Patients’ questionnaire |
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 |
b) Health-care providers are satisfied with cleanliness and comfort (yes/no) | Physicians’ and other HCPs’ questionnaires | |
E2. The service is welcoming | Patient is satisfieda with welcome (yes/not yes) | Patients’ questionnaire |
E3. Waiting times in the clinic are acceptable | a) Waiting time (minutes) per visit is recorded by patient in exit questionnaire | Patients’ questionnaire |
b) Patient is satisfieda with waiting time (yes/not yes) | Patients’ questionnaire | |
c) Health-care providers are satisfied with waiting times (yes/no) | Physicians’ and other HCPs’ questionnaires | |
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 |
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) | Physicians’ questionnaire |
G2. Costs of the service are measured as part of a cost-effectiveness policy | A record of input costs exists (yes/no) | Physicians’ questionnaire |
G3. There is equal access to headache services for all who need it | A policy to ensure equal access exists (yes/no) | Physicians’ questionnaire |
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) | Physicians’ questionnaire |
b) Outcomes according to this measure are recorded in patient’s record (yes/no/not applicable) | Patients’ records | |
H2. Outcome measures are based on self-reported disability burden | a) An outcome measure (HALT or similar) is available (yes/no) | Physicians’ questionnaire |
b) Outcomes according to this measure are recorded in patient’s record (yes/no/not applicable) | Patients’ records | |
H3. Outcome measures are based on self-reported quality of life | a) An outcome measure (WHOQoL or similar) is available (yes/no) | Physicians’ questionnaire |
b) Outcomes according to this measure are recorded in patient’s record (yes/no/not applicable) | Patients’ records | |
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 |
I2. Systems are in place to be aware of serious adverse eventsC | a) Serious adverse events are recorded | Patients’ records |
b) A protocol exists for reporting serious adverse events (yes/no) | Physicians’ questionnaire | |