A Delphi panel consensus study validating the appropriateness, relevance, and clarity of quality measures for...

A set of quality measures for chiropractic care was recently developed from relevant clinical guidelines, best practices, and care standards. This study used consensus methods to further refine the preliminary set as part of a stepwise validation process.

A modified online Delphi consensus study was conducted with chiropractic practitioners and administrators in integrated settings, clinical administrators at Council on Chiropractic Education (CCE)- accredited academic institutions, and CCE-accredited residency program directors. We invited panelists in these roles because integrated care and academic environments frequently assess elements of quality, increasing panelists' familiarity with quality measure concepts. Panelists rated 70 initial measures organized by Donabedian category (structure, process, outcome). Each measure was rated for clarity, relevance for patients, families, clinicians, or health organizations, and appropriateness for evaluating an element related to quality. Consensus was defined as: (1) At least 80% of appropriateness ratings in the 7-9 range; (2) Median appropriateness rating in the 7-9 range; and (3) at least 80% of responses indicating relevance to 1 or more groups. Following the consensus process, authors identified structure and process measures lacking a corresponding measure and developed new measures to fill gaps.

Forty-six panelists rated measures across 2 rounds. In Round 1, 51 (73%) measures met consensus. Of those, 14 were revised for clarity, and 3 were divided into 7 separate measures to ensure each measured individual components. Of the 19 (27%) that did not meet consensus, 10 were removed. In Round 2, 1 unrevised and 8 revised measures were re-rated with accompanying text explaining revisions and rationale for including each. Six met consensus. After Round 2, 3 additional measures were developed by authors to ensure process and structure measures were supported by a matching measure, resulting in a final set of 64. Five measures corresponded with the Donabedian category of outcome, 26 process, and 33 structure.

This study established consensus on the clarity, relevance, and appropriateness of a preliminary set of quality measures for chiropractic care. Patient input, pilot testing, and data to inform implementation feasibility and prioritization in different settings are needed to further develop quality measures.