Developing guideline-based key performance indicators for recurrent miscarriage care: lessons from a multi-stage...

Area of Science:

• Reproductive Medicine
• Healthcare Quality Improvement
• Clinical Governance

Background:

• Recurrent miscarriage care lacks standardized pathways, leading to inconsistent clinical practice.
• There is a need for guideline-based key performance indicators (KPIs) to evaluate national recurrent miscarriage services.
• Previous KPI development exercises have often excluded diverse stakeholder groups.

Purpose of the Study:

• To outline the process and experiences of developing guideline-based KPIs for recurrent miscarriage care.
• To involve a diverse stakeholder group in creating KPIs for evaluating national services.
• To address the inconsistency and poor organization in current recurrent miscarriage care.

Main Methods:

• Systematic review of clinical practice guidelines for recurrent miscarriage care.
• Modified e-Delphi survey and virtual meetings with diverse stakeholders to achieve consensus.
• Development and prioritization of candidate KPIs through participatory methods.

Main Results:

• 110 KPIs were prioritized from an initial list of 373 recommendations and 14 outcomes.
• KPIs cover structure of care (20), counseling (7), investigations (30), treatment (34), and outcomes (19).
• Stakeholder feedback highlighted accessibility, diversity, and streamlining as key process themes.

Conclusions:

• Developing guideline-based KPIs with diverse stakeholders is both important and feasible.
• A suite of 110 prioritized KPIs is established for recurrent miscarriage care evaluation.
• This experience can guide similar KPI development projects, especially those lacking clinical guidelines or involving multiple stakeholders.