Abstract
Background
Abnormal uterine bleeding (AUB) is a common women's health complaint. However, the
quality of primary care (PC) management of AUB is unknown. Our objective was to develop
quality indicators for Veterans Health Administration (VA) PC assessment and management
of AUB.
Methods
We drafted candidate indicators based on comprehensive review of the scientific literature,
including published consensus guidelines. Then, we convened a national panel of nine
experts including PC providers, obstetrician-gynecologists, VA policy stakeholders,
and quality measurement experts, and used a modified Delphi panel process. First,
panelists individually rated 19 candidate indicators, using 9-point scales, on three
metrics: consistency with established guidelines, importance to women's health, and
reliability of measurement from VA electronic health records. Panelists then discussed
the indicators. Finally, panelists re-rated revised indicators using the same metrics.
Indicators were selected if final median ratings were ≥7 on each 9-point scale, without
dispersion in ratings.
Results
Eighteen indicators were selected. Three focused on assessing need for emergency care
(e.g., profuse bleeding or pregnancy). Three addressed ascertaining key aspects of
the medical history (e.g., endometrial cancer risk). Two addressed performing a physical
examination (e.g., pelvic examination). Six addressed indications for diagnostic studies
and specialty care referrals, (e.g., transvaginal ultrasound examination). Four addressed
initiation of treatment and counseling (e.g., hormone therapy).
Conclusions
We developed quality indicators for PC assessment and management of AUB that span
reproductive and postmenopausal life phases. Applying these indicators in VA and other
health systems with integrated electronic health records can assess need for, and
effects of, AUB quality improvement programs.
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Biography
Donna L. Washington, MD, MPH, is Women's Health Focused Research Area Lead, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, and Professor of Medicine at UCLA. Her research examines health care access, quality, and equity for women/vulnerable populations.
Biography
Marjorie Danz, MD, is a health care services researcher with VA Greater Los Angeles Healthcare System and an Associate Scientist (Adjunct) with the RAND Corporation. Her research focuses on assessing and improving quality of care and quality of care reporting.
Biography
LaShawnta Jackson, DrPH, is a research health scientist with VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy. Her interests include social determinants of health, health equity, and implementation research.
Biography
Kristina M. Cordasco, MD, MPH, MSHS, is a researcher and internal medicine physician, VA Greater Los Angeles Healthcare System, and Associate Clinical Professor of Medicine, The University of California, Los Angeles. Her research focuses on quality, care coordination, and organization of care.
Article info
Publication history
Published online: December 15, 2018
Accepted:
November 7,
2018
Received in revised form:
October 1,
2018
Received:
April 26,
2018
Footnotes
Funded by the Veterans Health Administration (VHA) Health Services Research & Development (HSR&D) Service through HSR&D CREATE project #CRE-12-031.
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.
