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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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Developing Balanced Quality Indicators for Monitoring Virtual Care in Ambulatory Care Environments: Modified Delphi

Samuel Petrie1,2, Oluwatoni Makanjuola3,4, Celia Laur3,4

  • 1Implementation Science Team, Research, Innovation, and Discovery, Nova Scotia Health, Halifax, NS, Canada.

Journal of Medical Internet Research
|June 16, 2025
PubMed
Summary
This summary is machine-generated.

A new scorecard with 25 quality indicators was developed to evaluate ambulatory virtual care, focusing on patient experience, provider experience, population health, health equity, and costs. This tool aids in assessing virtual care quality and identifying areas for improvement.

Keywords:
Delphi panelperformance assessmentqualityquality indicatorsquintuple aimvirtual care

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Area of Science:

  • Health Services Research
  • Digital Health
  • Quality Improvement

Background:

  • The COVID-19 pandemic accelerated virtual visit adoption, but quality assessment remains under-explored.
  • Limited guidance exists for evaluating virtual care initiatives.

Purpose of the Study:

  • To develop a balanced set of quality indicators for ambulatory virtual care.
  • To integrate the Quintuple Aim framework and National Academy of Medicine quality domains, including sustainability.
  • To establish a framework for monitoring virtual care quality.

Main Methods:

  • A modified Delphi panel process with 19 Canadian experts (clinicians, patients, policymakers, academics, administrators) was used.
  • Quality indicators were curated from literature and user feedback, then rated and ranked over three rounds.
  • Indicators were evaluated against the Quintuple Aim and National Academy of Medicine Quality Domains using a 9-point Likert scale.

Main Results:

  • 140 initial indicators were refined through the Delphi process, with 89% panel participation.
  • A final scorecard includes 25 quality indicators for ambulatory virtual care.
  • The indicators cover patient experience (13), provider experience (6), population health (2), health equity (2), and health system costs (2).

Conclusions:

  • A consensus-based set of 25 quality indicators for ambulatory virtual care has been established.
  • This scorecard enables comprehensive virtual care evaluations and comparisons across jurisdictions.
  • It supports identifying priority areas and ensuring high-quality virtual care delivery.