Quality indicators for rural surgical and obstetrical care: A modified Delphi consensus study

Area of Science:

• Healthcare Quality Improvement
• Rural Health Services Research
• Surgical and Obstetrical Care Evaluation

Background:

• Measuring surgical and obstetrical care quality in low-volume rural hospitals presents unique challenges.
• Existing quality metrics may not adequately reflect the realities of rural healthcare settings.
• A contextually relevant framework is needed for evaluating rural healthcare quality.

Purpose of the Study:

• To establish consensus-based, contextually relevant indicators for assessing surgical and obstetrical care quality in rural hospitals.
• To adapt quality measurement methodologies for the specific constraints and characteristics of low-volume rural settings.

Main Methods:

• A modified Delphi process involving two rounds of electronic surveys was employed.
• Fifty-one Canadian healthcare professionals, including rural proceduralists and quality experts, participated.
• Participants rated the priority of proposed quality metrics, with consensus reached on 115 of 177 measures.

Main Results:

• A significant proportion (65%) of proposed quality measures achieved consensus.
• Expert participants agreed on the prioritization of these measures for rural surgical and obstetrical quality evaluation.
• Qualitative feedback highlighted the low relevance of rare adverse outcomes in low-volume rural contexts and emphasized practical data interpretation.

Conclusions:

• The modified Delphi process successfully identified surgical and obstetrical quality indicators tailored to rural practice realities.
• The methodology accommodated factors often missed in urban-centric approaches, such as team-based care and limited specialist access.
• These contextually embedded indicators offer a more appropriate framework for quality assessment in rural healthcare.