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P169 A consensus of outcome measures to monitor and enhance the quality of an inflammatory bowel disease surgical service provision: results from a pan-European, multicentre, Delphi study

P. Morar*1, N. Sevdalis2, C. Edwards3, A. Hart1, W. Bemelman4, J. Warusavitarne1, O. Faiz1

1St Mark’s Hospital, Colorectal Surgery & IBD Unit, London, United Kingdom, 2Imperial College London, Surgery and Cancer, London, United Kingdom, 3Torbay Hospital, Gastroenterology, Torbay, United Kingdom, 4AMC, Surgery, Amsterdam, Netherlands

Background

There is a current drive to reduce variation in standards of healthcare and improve the quality of surgical services provided to patients with IBD. Currently no evidence-based definitions exist for what would constitute outcome measures in this setting. Various qualitative measurement techniques have been adopted by healthcare services with the aim of improving standards. The aim of this study was to obtain a definition of outcome measures in IBD surgery to monitor and enhance an IBD surgical service provision.

Methods

This was a prospective, multicentre, 2-stage qualitative study. Stage 1 used semistructured interviews across a multidisciplinary sample of 27 participants. Items identified were incorporated into stage 2. Stage 2 used a Delphi formal consensus-building methodology. Experts were recruited through the European Crohn’s and Colitis Organisation. An eligibility criterion was established to ensure Delphi panellists had expertise in the field of IBD. Panellists were asked to rank each item with a Likert scale which was categorised from 1 (= not important) to 5 (= highly important). Successive rounds were carried out, with participants being informed of aggregated responses, until formal consensus was reached. Likert rankings were represented with median scores and interquartile ranges (IQR). Consensus was defined with an IQR ≤ 1. Items with a median score > 3, and IQR ≤ 1, were included into the eligibility criteria.

Results

Stage 1: 27 semistructured interviews (9 consultant surgeons, 4 IBD nurse specialists, 5 gastroenterologists, 4 service managers, and 5 patients) were performed. Stage 2: the expert consensus panel consisted of 21 participants (7 consultant gastroenterologists and 14 consultant surgeons), recruited across 18 centres.

Figure 1. Map of Europe demonstrating institutions from which expert consensus panellist work.

Consensus was obtained for 81.8% (27/33) items following 2 iterations. The table below demonstrates items, alongside median Likert scores. Items achieving inclusion are highlighted.

Table demonstrating outcome measures for an IBD surgical service provision.

Items demonstrating consensus for importance (median Likert > 3, IQR < 1) are highlighted.

Conclusion

Devising key performance indicators for an IBD surgical service provision is necessary to improve the quality of care for patients undergoing IBD surgery. This study has provided outcome measures for IBD surgery, through expert consensus. These standardised outcome measures can be used for auditing institutions and research purposes.