Background
Methods
Overview of methods, registration and reporting
Search strategy
Inclusion criteria
Selection of indicators
Data extraction
Quality assessment of indicators
Data synthesis
Results
Characteristics of included studies
Author, year, country | Title | Indicators for the acute management of anaphylaxis | Indicators for the long-term management of anaphylaxis | No of indicators |
---|---|---|---|---|
European Academy of Allergy and Clinical Immunology (EAACI), 2014, Europe | Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology | Yes | Yes | 24 |
Levy M, 2008, UK | Audit of self-administered injectable adrenaline prescription in primary care | Yes | Yes | 6 |
National Institute for Health and Clinical Excellence (NICE), 2011, UK | Anaphylaxis clinical audit tool implementing NICE guidelines | Yes | Yes | 8 |
Royal College of Paediatrics and Child Health (RCPCH), 2011, UK | RCPCH Allergy Care Pathways Project Audit criteria | Yes | Yes | 9 |
Stang AS, et al., 2013, Canada | Quality indicators for high acuity pediatric conditions | Yes | No | 7 |
Assessment of indicators against AHRQ criteria
Reference | Identification of candidate indicators | Assessment of candidate indicators | Implementation | Maintenance | Retirement | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Literature review | Conceptual model | Expert engagement | Initial spec | Second literature review | Panel review | Risk adjustment | Empirical analysis | Coding | Testing | User documentation | |||
EAACI | No | Yes | Yes | No | No | No | No | No | No | No | No | No | No |
Levy | No | Yes | Yes | Unclear | No | No | No | No | Yes | Yes | Yes | No | No |
NICE | No | Yes | Yes | Yes | No | Unclear | Unclear | No | No | Unclear | Unclear | No | No |
RCPCH | No | Yes | Yes | No | No | No | No | Unclear | No | Unclear | Unclear | No | No |
Stang | Yes | Yes | Yes | Yes | Unclear | Yes | Yes | Yes | Yes | Yes | Yes | No | No |
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1. Measure developmentThe EAACI indicators [12] were derived from clinical guidelines in relation to key recommendations. The Levy indicators [14] were developed through expert consensus. The National Institute of Health and Clinical Excellence (NICE) indicators were derived from relevant guideline recommendations [15]. The Royal College of Paediatrics and Child Health (RCPCH) indicators were derived from a care pathway for children with suspected anaphylaxis [16]. The Stang indicators [17] were the only ones that had been developed through the stages suggested by AHRQ, namely formal processes to identify and assess indicators; furthermore, these were developed using National Quality Framework (NQF) measure evaluation criteria [19].
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2. ImplementationThe EAACI indicators [12] did not have any formal implementation assessment. The Levy indicators [14] are freely available for use from http://www.guideline-audit.com/adrenaline/audit_specification.php and had been successfully implemented in a number of UK general practices with the opportunity for benchmarking quality of care. NICE [15] had a generic implementation team and created a range of implementation tools, but it was unclear if the ability to implement these indicators in practice had been formally assessed. The RCPCH [16] give no mention of an implementation strategy. The Stang indicators were operationalized and tested in an ED setting [17].
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3. MaintenanceNone of the indicators had plans for formal maintenance checks.
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4. Retirement