Quality Indicator Development for the Approach to Ineffective Esophageal Motility: A Modified Delphi Study

Area of Science:

• Gastroenterology
• Esophageal Physiology
• Medical Quality Improvement

Background:

• Ineffective esophageal motility (IEM) is diagnosed in up to 20% of patients via high-resolution manometry (HRM).
• The clinical significance and optimal management of IEM remain poorly defined.
• Current diagnostic criteria are based on the Chicago Classification.

Purpose of the Study:

• To develop and establish consensus-based quality indicators for ineffective esophageal motility (IEM).
• To provide a framework for assessing and improving the clinical management of IEM.
• To identify areas requiring further research regarding IEM.

Main Methods:

• A modified-Delphi approach utilizing the RAND/UCLA Appropriateness Methods was employed.
• Twelve proposed quality indicator statements were developed based on existing literature.
• Ten esophageal experts participated in a 3-round iterative process of independent and blinded scoring and virtual discussion.

Main Results:

• Two quality indicators for IEM achieved comprehensive agreement among experts.
• Four indicators reached partial agreement, and one showed no agreement.
• Consensus was reached on assessing IEM's clinical relevance and managing GERD, with disagreement on pro-motility agents and mixed views on surgical planning.

Conclusions:

• A robust methodology successfully identified two quality indicators for IEM.
• These indicators can standardize performance tracking for IEM identified on HRM.
• The study underscores the challenges in IEM management and the necessity for further investigation into its clinical importance.