Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review

Area of Science:

• Healthcare Quality Improvement
• Health Services Research
• Methodology

Background:

• The Delphi technique is a structured communication method frequently employed for developing healthcare quality indicators.
• Despite its common use, there is a lack of comprehensive guidance for researchers utilizing the Delphi method in this context.
• This study addresses the need for improved reporting and methodological rigor in Delphi-based quality indicator development.

Purpose of the Study:

• To describe the current reporting standards of the Delphi method in the development of healthcare quality indicators.
• To discuss essential methodological skills required for effective quality indicator selection using the Delphi technique.
• To provide practical guidance for researchers to enhance their application and reporting of the Delphi method.

Main Methods:

• A systematic literature search was conducted across three electronic databases for studies published between 1978 and 2009 that employed the Delphi method for quality indicator selection.
• A standardized data extraction form assessed reporting across four domains: questionnaire preparation, expert panel characteristics, survey progress, and Delphi results.
• Eighty studies were included in the analysis, evaluating the quality of reporting for various methodological aspects.

Main Results:

• Reporting quality varied significantly across studies, with critical information such as response rates (39%), feedback provision (60%), consensus methods (77%), and listed quality indicators (57%) often insufficiently reported.
• Modified Delphi procedures were common (63%), often involving physical meetings.
• Expert panels typically comprised 17 members (median), frequently including multiple stakeholders (57%), predominantly healthcare professionals (95%).
• Criteria for selecting quality indicators, such as validity (37%) and feasibility (23%), were inconsistently reported.

Conclusions:

• The current application and reporting of the Delphi method for selecting healthcare quality indicators require substantial improvement.
• Enhanced methodological rigor and transparent reporting are crucial for ensuring the reliability and validity of Delphi-derived quality indicators.
• The study offers guidance to researchers to improve the utilization and reporting of the Delphi technique in future quality indicator development initiatives.