Defining quality indicators for atherosclerotic cardiovascular diseases in primary care, extractable from the electronic health record: a RAND-modified Delphi method.

BACKGROUND: Atherosclerotic cardiovascular diseases (ASCVD) account for 85% of all cardiovascular diseases and put a substantial burden on healthcare systems. General practitioners play an important role in managing ASCVD. The management of ASCVD could be improved by audit and feedback (A&F) based on quality indicators (QIs) derived from the electronic health record (EHR) of the general practitioner. This study aimed to define a set of validated and EHR extractable QIs for ASCVD to support A&F in primary care. METHODS: A RAND-modified Delphi method was employed to define QIs. Recommendations were selected based on the SMART principle from international guidelines, selected following the AGREE II evaluation. After assessment by a multidisciplinary expert panel, the recommendations were analyzed using the median Likert Scale score, prioritization, and degree of agreement. They were preliminary classified as having high, uncertain or low potential to measure the quality of ASCVD care. These recommendations were further discussed in a consensus meeting. Upon final validation, high-potential recommendations were converted into QIs. RESULTS: A questionnaire composed of 92 recommendations, selected from 12 international guidelines, were presented to the panel, resulting in a set of 50 high-potential recommendations. These were merged and modified into 41 recommendations after the consensus meeting. This resulted in a final set of 41 QIs classified into four categories: follow-up (N = 4), pharmacological treatment (N = 22), patient education (N = 10), and referral (N = 5). CONCLUSIONS: This study defines a set of 41 EHR extractable QIs for ASCVD in primary care, supporting A&F in primary care.