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PubMed2002

How can primary concerns of school district superintendents guide school health efforts?

School-based research and health promotion interventions typically require upper administration support and acceptance to succeed. This paper focuses on a recently completed Delphi survey of the majority of school district superintendents in a frontier state. The survey examined superintendent district-level concerns at the elementary, middle/junior high, and high school levels. Primary concerns revolved around school funding, classroom education and student achievement, and teacher-centered issues. Implications for this research are discussed as are the importance of these data to those interested in working with schools to improve student health. The importance of this information for implementation of coordinated school health programs also is discussed.

Delphi Technique↗

PubMed2002

Characteristics of effective providers of marital and family therapy in rural mental health settings.

Characteristics of effective providers of marital and family therapy (MFT) in rural mental health settings were investigated. The survey sample included 74 members of the National Association for Rural Mental Health who, through a modified Delphi process, created a composite picture of effective MFT providers. The findings yielded six major rank-ordered characteristics of effective MFT providers in rural mental health settings, with effective skills in MFT ranked first. Rural community understanding, appreciation and participation ranked second. Specific competencies contributing to each major characteristic were also identified and are discussed. Recommendations for use of this information are provided.

Delphi Technique↗

PubMed1999

Development of effectiveness of care and use of services measures for dental care plans.

OBJECTIVES: Standardized measures to assess clinical aspects of the performance of managed dental care plans are not available. This project sought to develop and evaluate measures for effectiveness of care and use of services that could be calculated using a plan's administrative data. METHODS: Two panels of stake holders representing dental plans, purchasers, and dental providers participated in a modified Delphi process to refine initial sets of effectiveness of care and use of services measures modeled after HEDIS measures for medical care. The refined measures were then pilot tested in two dental health maintenance organizations. RESULTS: The development process resulted in specification of seven effectiveness of care measures assessing disease activity classification, and prevention and outcomes for caries, periodontal disease, and tooth loss. Six use of services measures focusing on prophylaxes, third molar surgery, preventive, restorative, prosthetic, surgical, and endodontic care also were specified. Pilot testing of the measures indicated reasonable reliability and sensitivity, but also demonstrated the need for supervision or auditing of the process. CONCLUSIONS: These standardized measures for dental care plan performance are available for immediate use. However, because the measures depend on diagnostic information (periodontal probing data and diagnoses associated with restorative treatments) in the administrative data set, their adoption will require changes in most plans' data systems and data collection policies.

Adolescent↗

PubMedDate not supplied

A quality mix: using evidence and experience to evaluate new technologies.

This article describes BlueCross BlueShield of Tennessee's (BCBST) success in blending evidence with experience. This process has provided a winning solution for members, providers, and the health plan. Provider input has proved to be an invaluable tool in assessing both new and established technologies. BCBST uses a variety of methods, from formal panels to a modified Delphi approach, to obtain provider input into the creation of clinical decision tools. Provider experience fills the gap in the assessment of technologies that are widely used but do not have sufficient evidence to support them. This approach has significant implications for health plan delivery. It also meets the Institute of Medicine's concern that every healthcare organization, purchaser, regulator and educational institution encourage the delivery of services based upon the best available scientific knowledge.

Blue Cross Blue Shield Insurance Plans↗

PubMed2001

An evidence and consensus based guideline for acute diarrhoea management.

OBJECTIVE: To develop an evidence and consensus based guideline for the management of the child who presents to hospital with diarrhoea (with or without vomiting), a common problem representing 16% of all paediatric medical attenders at an accident and emergency department. Clinical assessment, investigations (biochemistry and stool culture in particular), admission, and treatment are addressed. The guideline aims to aid junior doctors in recognising children who need admission for observation and treatment and those who may safely go home. EVIDENCE: A systematic review of the literature was performed. Selected articles were appraised, graded, and synthesised qualitatively. Statements on recommendation were generated. CONSENSUS: An anonymous, postal Delphi consensus process was used. A panel of 39 selected medical and nursing staff were asked to grade their agreement with the generated statements. They were sent the papers, appraisals, and literature review. On the second and third rounds they were asked to re-grade their agreement in the light of other panelists' responses. Consensus was predefined as 83% of panelists agreeing with the statement. RECOMMENDATIONS: Clinical signs useful in assessment of level of dehydration were agreed. Admission to a paediatric facility is advised for children who show signs of dehydration. For those with mild to moderate dehydration, estimated deficit is replaced over four hours with oral rehydration solution (glucose based, 200-250 mOsm/l) given "little and often". A nasogastric tube should be used if fluid is refused and normal feeds started following rehydration. Children at high risk of dehydration should be observed to ensure at least maintenance fluid is tolerated. Management of more severe dehydration is detailed. Antidiarrhoeal medication is not indicated. VALIDATION: The guideline has been successfully implemented and evaluated in a paediatric accident and emergency department.

Acute Disease↗

PubMed2002

Acupuncture for tennis elbow: an E-mail consensus study to define a standardised treatment in a GPs' surgery.

Acupuncture is a possible alternative treatment for tennis elbow in general practice. Rigorous investigation of its effectiveness is needed by means of a randomised controlled trial. Before undertaking a trial, a consensus is required on the best treatment protocol. Therefore, a modified Delphi Process was undertaken by e-mail, consisting in three iterative rounds. Fourteen acupuncture trainers initially reported details of their normal treatment that were then incorporated into a treatment plan. This was circulated once for further suggestions and finally for agreement. Consensus was achieved from all 14 participants who responded to the third round.

Acupuncture Therapy↗

PubMed2005

EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides.

BACKGROUND: There has been a lack of appropriate classification criteria for vasculitis in children. OBJECTIVE: To develop a widely accepted general classification for the vasculitides observed in children and specific and realistic classification criteria for common childhood vasculitides (Henoch-Schönlein purpura (HSP), Kawasaki disease (KD), childhood polyarteritis nodosa (PAN), Wegener's granulomatosis (WG), and Takayasu arteritis (TA)). METHODS: The project was divided into two phases: (1) the Delphi technique was used to gather opinions from a wide spectrum of paediatric rheumatologists and nephrologists; (2) a consensus conference using nominal group technique was held. Ten international experts, all paediatricians, met for the consensus conference. Agreement of at least 80% of the participants was defined as consensus. RESULTS: Consensus was reached to base the general working classification for childhood vasculitides on vessel size. The small vessel disease was further subcategorised into "granulomatous" and "non-granulomatous." Final criteria were developed to classify a child as HSP, KD, childhood PAN, WG, or TA, with changes introduced based on paediatric experience. Mandatory criteria were suggested for all diseases except WG. CONCLUSIONS: It is hoped that the suggested criteria will be widely accepted around the world because of the reliable techniques used and the international and multispecialist composition of the expert group involved.

Child↗

PubMed2006

Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review.

BACKGROUND: Eccentric overload training seems to be a promising conservative intervention in patients with chronic Achilles tendinopathy. The efficacy of eccentric overload training on the outcome measures of pain and physical functioning are not exactly clear. STUDY DESIGN: Systematic review of the literature. METHODS: Electronic databases were searched for randomised clinical trials concerning eccentric overload training in patients with chronic Achilles tendinopathy. The Delphi list was used to assess the methodological quality of the studies. RESULTS: Nine clinical trials were included. Only one study had sufficient methodological quality. The included trials showed an improvement in pain after eccentric overload training. Because of the methodological shortcomings of the trials, no definite conclusion can be drawn concerning the effects of eccentric overload training in patients with chronic Achilles tendinopathy. CONCLUSION: The effects of eccentric exercise training in patients with chronic Achilles tendinopathy on pain are promising; however, the magnitude of the effects cannot be determined. Large, methodologically sound studies from multiple sites in which functional outcome measures are included are warranted.

Achilles Tendon↗

PubMed2000

Validation of an instrument for injury data collection in rugby union.

OBJECTIVE: To provide the basis for collecting rugby union injury data using a rigorously validated injury report form. METHODS: Seven stages were used to assess face, content, and criterion validity of the rugby union injury report form. A 22 member panel plus four sporting bodies assessed the form for face validity, and an expert panel assessed it for content and criterion validity. Panel members were consulted until consensus was reached. A yardstick developed by an expert panel using the Delphi technique was used to assess the reliability of the form. An independent panel of 10 viewed a series of five videotaped injuries, three times over a five week period to assess inter-rater and intrarater reliability. The form was then trialed by 40 people in situ during four games. RESULTS: The rugby union injury report form for games and training was developed, and the face, content, and criterion validity successfully assessed. A seven step protocol to create a yardstick was also developed to assist in the validation process. Both inter-rater and intrarater reliability results indicated a 98% agreement. The 40 trialists who completed forms in situ during four games were found to have an inter-rater reliability agreement of 98% for nine injuries. CONCLUSIONS: A measurement instrument for injury data collection in rugby union was successfully developed and validated, providing researchers with a basis for future studies in this area. A procedure to develop future injury data collection instruments in other sports was also developed.

Data Collection↗

PubMed1995

Consensus methods for medical and health services research.

Health providers face the problem of trying to make decisions in situations where there is insufficient information and also where there is an overload of (often contradictory) information. Statistical methods such as meta-analysis have been developed to summarise and to resolve inconsistencies in study findings--where information is available in an appropriate form. Consensus methods provide another means of synthesising information, but are liable to use a wider range of information than is common in statistical methods, and where published information is inadequate or non-existent these methods provide a means of harnessing the insights of appropriate experts to enable decisions to be made. Two consensus methods commonly adopted in medical, nursing, and health services research--the Delphi process and the nominal group technique (also known as the expert panel)--are described, together with the most appropriate situations for using them; an outline of the process involved in undertaking a study using each method is supplemented by illustrations of the authors' work. Key methodological issues in using the methods are discussed, along with the distinct contribution of consensus methods as aids to decision making, both in clinical practice and in health service development.

Consensus Statements as Topic↗

PubMed2002

Sports medicine and the accident and emergency medicine specialist.

BACKGROUND: Sport and exercise related injuries are responsible for about 5% of the workload in the accident and emergency (A&E) department, yet training in sports medicine is not a compulsory part of the curriculum for Higher Specialist Training. AIM: To determine how A&E medicine consultants and specialist trainees view their role and skill requirements in relation to sports medicine. METHOD: A modified Delphi study, consisting of two rounds of a postal questionnaire. Participants were invited to rate the importance of statements relating to the role and training of the A&E specialist in relation to sports injuries (six statements) and the need for knowledge and understanding of defined skills of importance in sports medicine (16 statements). VALUE OF RESEARCH: This provides a consensus of opinion on issues in sport and exercise medicine that have educational implications for A&E specialists, and should be considered in the curriculum for Higher Specialist Training. There is also the potential for improving the health care provision of A&E departments, to the exercising and sporting population.

Athletic Injuries↗

PubMed2003

An evidence and consensus based guideline for the management of a child after a seizure.

OBJECTIVE: An evidence and consensus based guideline for the management of the child who presents to hospital having had a seizure. It does not deal with the child who is still seizing. The guideline is intended for use by junior doctors, and was developed for this common problem (5% of all paediatric medical attenders) where variation in practice occurs. OPTIONS: Assessment, investigations (biochemistry, lumbar puncture, serum anticonvulsant levels, EEG in particular), and/or admission are examined. OUTCOMES: The guideline aims to direct junior doctors in recognising those children who are at higher risk of serious intracranial pathology including infection, and conversely to recognise those children at low risk who are safe to go home. EVIDENCE: A systematic review of the literature was performed. Articles were identified using the electronic data bases Medline (from 1966 to June 1998), Embase (from 1980 to June 1998) and Cochrane (to June 1998), and selected if they investigated the specified clinical question. Personal reviews were excluded. Selected articles were appraised, graded, and synthesised qualitatively. Statements of recommendation were made. CONSENSUS: An anonymous, postal Delphi consensus development was used. A national panel of 30 medical and nursing staff regularly caring for these children were asked to grade their agreement with the statements generated. They were sent the relevant original publications, the appraisals, and literature review. On the second and third rounds they were asked whether they wished to re-grade their agreement in the light of other panellists' responses. Consensus was defined as 83% of panellists agreeing with the statement. Recommendations in brief: For afebrile seizures all children should have their blood pressure recorded, but no other investigations are routine although a seizing or somnolent child should have blood glucose measured; all children under 1 year should be admitted. For seizures with fever, clinical signs indicating the need to treat as meningitis are given. Children should be admitted if they are under 18 months old, have had a complex seizure, or after pretreatment with antibiotics. VALIDATION: The guideline has undergone implementation and evaluation in a paediatric accident and emergency department, the results of which will be published separately. Only one alteration was made to the guideline as a result of this validation process, which is included here.

Algorithms↗

PubMed2006

Who's who at a major incident: standardising role titles for emergency planners.

OBJECTIVE: To standardise the names for key roles in a major incident. METHODS: A Delphi study using experts in major incident planning. RESULTS: There is clear consensus regarding the need for standard nomenclature. The expert group identified 28 roles, and 184 different names were initially given by group members for the 28 roles. Agreement on a common nomenclature was achieved in only 12/28 roles. CONCLUSION: There is agreement for a standardised nomenclature for major incident roles. However, consensus may be difficult to achieve from within an expert group.

Consensus↗

PubMed1996

Research priorities in occupational medicine: a survey of United Kingdom personnel managers.

A Delphi survey was carried out in an attempt to identify areas of priority in occupational health that should be targeted by research. Previously 53 occupational physicians identified and ranked these areas. These were then assessed by personel managers. There was considerable agreement on priorities between the two groups with musculoskeletal disorders and stress securing the highest ranking.

Delphi Technique↗

PubMed1998

Surveillance case definitions for work related upper limb pain syndromes.

OBJECTIVES: To establish consensus case definitions for several common work related upper limb pain syndromes for use in surveillance or studies of the aetiology of these conditions. METHODS: A group of healthcare professionals from the disciplines interested in the prevention and management of upper limb disorders were recruited for a Delphi exercise. A questionnaire was used to establish case definitions from the participants, followed by a consensus conference involving the core group of 29 people. The draft conclusions were recirculated for review. RESULTS: Consensus case definitions were agreed for carpal tunnel syndrome, tenosynovitis of the wrist, de Quervain's disease of the wrist, epicondylitis, shoulder capsulitis (frozen shoulder), and shoulder tendonitis. The consensus group also identified a condition defined as "non-specific diffuse forearm pain" although this is essentially a diagnosis made by exclusion. The group did not have enough experience of the thoracic outlet syndrome to make recommendations. CONCLUSIONS: There was enough consensus between several health professionals from different disciplines to establish case definitions suitable for use in the studies of several work related upper limb pain syndromes. The use of these criteria should allow comparability between studies and centres and facilitate research in this field. The criteria may also be useful in surveillance programmes and as aids to case management.

Arm↗

PubMed2001

Research priorities in occupational health in Italy.

OBJECTIVE: To find a broad consensus on research priorities and strategies in the field of occupational health and safety in Italy. METHODS: A two phase questionnaire survey was based on the Delphi technique previously described in other reports. 310 Occupational safety and health specialists (from universities and local health units) were given an open questionnaire (to identify three priority research areas). The data obtained from respondents (175, 56.4%) were then used to draw up a list of 27 priority topics grouped together into five macrosectors. Each of these was given a score ranging from 1 (of little importance) to 5 (extremely important). With the mean scores obtained from a total of 203 respondents (65.4%), it was possible to place the 27 topics in rank order according to a scale of priorities. RESULTS: Among the macrosectors, first place was given to the question of methodological approach to research in this field, and for individual topics, occupational carcinogenesis and quality in occupational medicine were ranked first and second, respectively. The question of exposure to low doses of environmental pollutants and multiple exposures ranked third among the priorities; the development of adequate and effective approaches and methods for worker education and participation in prevention was also perceived as being an important issue (fourth place). CONCLUSIONS: This study (the first of its kind in Italy) enabled us to achieve an adequate degree of consensus on research priorities related to the protection of occupational health and safety. Disparities in the mean scores of some of the issues identified overall as being research priorities, seem to be linked both to geographical area and to whether respondents worked in local health units or universities. This finding requires debate and further analysis.

Decision Making↗

PubMed2003

Quality indicators for primary care mental health services.

OBJECTIVES: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement. DESIGN: Modified two-round postal Delphi questionnaire. SETTING: Geographical spread across Great Britain. PARTICIPANTS: One hundred and fifteen panellists representing 11 different stakeholder groups within primary care mental health services (clinical psychologist, health and social care commissioner, community psychiatric nurse, counsellor, general practitioner, practice nurse/district nurse/health visitor, psychiatrist, social worker, carer, patient and voluntary organisations). MAIN OUTCOME MEASURES: Face validity (median rating of 8 or 9 on a nine point scale with agreement by all panels) for assessing quality of care. RESULTS: A maximum of 334 indicators were rated by panels in the second round; 26% were rated valid by all panels. These indicators were categorised into 21 aspects of care, 11 relating to general practices and 10 relating to health authorities or primary care groups/trusts. There was variation in the total number of indicators rated valid across the different panels. Overall, GPs rated the lowest number of indicators as valid (41%, n=138) and carers rated the highest number valid (91%, n=304). CONCLUSIONS: The quality indicators represent consensus among key stakeholder groups in defining quality of care within primary care mental health services. These indicators could provide a guide for primary care organisations embarking on quality improvement initiatives in mental health care when addressing national targets and standards relating to primary care set out in the National Service Framework for Mental Health for England. Although many of the indicators relate to parochial issues in UK service delivery, the methodology used in the development of the indicators could be applied in other settings to produce locally relevant indicators.

Attitude of Health Personnel↗

PubMed1992

Development of indicators for quality assurance in public health medicine.

OBJECTIVES: To develop structure, process, and outcome indicators within a quality rating index for audit of public health medicine. DESIGN: Development of an audit matrix and indicator of quality through a series of group discussions with public health physicians, from which self administered weighted questionnaires were constructed by a modified Delphi technique. SETTING: Five Scottish health boards. SUBJECTS: Public health physicians in the five health boards. MAIN MEASURES: Indicators of quality and a quality rating index for seven selected service categories for each of seven agreed roles of public health medicine: assessment of health and health care needs in information services, input into managerial decision making in health promotion, fostering multisectoral collaboration in environmental health services, health service research and evaluation for child services, lead responsibility for the development and/or running of screening services, and public health medicine training and staff development in communicable disease. RESULTS: Indicators in the form of questionnaires were developed for each topic. Three types of indicator emerged: "global," "restricted," and "specific." A quality rating index for each topic was developed on the basis of the questionnaire scores. Piloting of indicators showed that they are potentially generalisable; evaluation of the system is under way across all health boards in Scotland. CONCLUSION: Measurable indicators of quality for public health medicine can be developed.

Data Collection↗