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Table 3 Suggested assessment template

From: Headache service quality: the role of specialized headache centres within structured headache services, and suggested standards and criteria as centres of excellence

Standard

Criterion

Verification

Target

Domain A. Competence of staff

1

Centre is staffed by headache specialists, who are sufficient but not excessive in number.

Each “headache specialist” can document:(a) advanced training (yes/no); (b) past and continuing experience in the field of headache (yes/no).

Number of specialists is: (c) sufficient (yes/no); (d) not excessive (yes/no).

(a, b) internal audit of CVs and continuing professional development records;

(c, d) internal audit of workload and waiting times

(a) 100% yes

(b) 100% yes

(c) aspirational

(d) yes

Domain B. Provision of care

2

Centre provides dedicated care for headache patients.

Patients with headache are seen in dedicated sessions, not within general neurological or other sessions (yes/no)

internal audit of clinic lists

yes as a general rule

3

Centre provides patients with a clear diagnosis made at earliest opportunity, information about their headache(s), advice on management and internationally-accepted evidence-based treatment.

(a) Diagnoses are always according to ICHD-3 (yes/no).

Disability assessments, diagnostic and follow-up diaries, outcome measures and patient information leaflets are: (b) all available (yes/no): (c) all routinely used (yes/no).

(d) National or international management guidelines are adopted (yes/no).

(a) internal audit of patients’ records;

(b) objectively verifiable;

(c) internal audit of patients’ records;

(d) objectively verifiable

(a) 100% yes

(b) yes

(c) yes

(d) yes

4

Centre provides multidisciplinary care full-time, and competently manages disorders underlying the full range of secondary headaches.

(a) Working collaborations exist between physicians, nurses, physical therapists and psychologists (yes/no).

(b) The centre is based within, or in geographical proximity to, a general hospital providing access to emergency department, neurology, neuroradiology, neurosurgery, psychiatry, ophthalmology, otorhinolaryngology, orthopaedics, rheumatology, cardiology, infectious diseases, endocrinology, paediatrics, gynaecology, dentistry (yes/no).

(c) Inpatient facilities are available for patients with certain comorbidities and for those needing supervised withdrawal from medication overuse (yes/no).

(a) existence is objectively verifiable;

(b) access is objectively verifiable;

(c) availability is objectively verifiable

(a) yes

(b) yes

(c) yes

Domain C. Quality evaluation and assurance

5

Centre monitors quality of care in order to optimize it.

Procedures are in place for recording clinical outcomes and adverse events, and service quality indicators (Table 4), with regular audits of all (yes/no).

objectively verifiable as present and happening

yes

Domain D. Networks and collaborations

6

Centre maintains quality of endeavour through networking, collaboration and the sharing of experience with other international and/or national centres.

(a) Existence and operation of networks and collaboration are documented by the centre (yes/no).

(b) Evidence is presented of any of the following (yes/no):

• exchange of ideas relating to service organization, patient care, teaching and/or research;

• exchange of staff and/or engagement in a fellowship exchange programme;

• collaborative research protocols;

• shared or collaborative educational programmes;

• shared or common database.

(a, b) verifiable by peer review

(a) yes

(b) yes to one or more

Domain E. Teaching

7

Centre is a principal resource for national postgraduate training in the field of headache.

Evidence is presented of recent or current engagement in at least two of the following (yes/no):

• development of national management guidelines, or adaptation of international guidelines for national use;

• development of learning materials for trainee headache specialists, neurologists and/or specialist nurses;

• delivery of didactic teaching and/or clinical demonstrations to trainee headache specialists, neurologists and/or specialist nurses on a regular basis;

• acceptance of clinical trainees on accredited attachments.

verifiable by peer review

yes to two or more

8

Centre provides support, through training and education, to health-care providers at levels 1 and 2.

Either:

(a) a programme of training and education is offered through formal links between the centre and health-care providers at levels 1 and 2 throughout the geographical area served by the centre (yes/no);

(b) where levels 1 and 2 are not in place within structured services, a programme of training and education is continuously available to local general practitioners, nurses and/or pharmacists (yes/no)

(a) objectively verifiable as in place;

(b) verifiable by peer review

yes to either

Domain F. Research

9

Centre is a principal fount of useful research output in the field of headache.

Research is either or both:

(a) of international value (yes/no);

(b) appropriate to the needs of the local community (yes/no).

peer review of quantity, quality and value of publications

yes to either

Domain G. Empirical support of existence

10

Centre supports and justifies its existence, and the development of others, by documenting and demonstrating its utility.

Activities and achievements:

(a) are documented (yes/no);

(b) provide evidence of utility (yes/no).

(a) objectively verifiable;

(b) verifiable by peer review

(a) yes

(b) yes