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PubMed2004

Cost effectiveness of bortezomib in the treatment of advanced multiple myeloma.

This study evaluated the cost effectiveness of bortezomib in relapsed, refractory myeloma, relative to best supportive care (BSC) and thalidomide. Data were derived from the phase 2 pivotal study of bortezomib, a Delphi panel of six myeloma thought leaders, and published literature. Objective assumptions regarding treatment choices and consequences (response and complications), and actual cost data were used. Bortezomib was found to be cost effective relative to BSC and thalidomide. Sensitivity analyses demonstrated the robustness of the results. These data suggest that bortezomib provides a cost-effective treatment option and the best value (in terms of cost/life-yr gained) among the currently available therapeutic options for relapsed, refractory myeloma.

Boronic Acids↗

PubMed2000

Occupational health nursing research priorities: a changing focus.

This article reports a study to reexamine and update the research priorities in occupational health nursing. In this investigation, a 15% geographically proportionate random sample of AAOHN members was surveyed using a two-stage Delphi technique to determine important occupational health related areas needing targeted research. Research participants evaluated 37 potential research priorities in relation to impact on worker health and value to the profession, and 12 priorities emerged.

Adult↗

PubMed2005

Criteria for identifying wound infection--revisited.

The accurate identification of wound infection provides a clinical challenge to those involved in patient care and would appear to have not kept pace with other developments in the field of wound care. Attempts have been made to improve on the situation but diverse opinions together with lack of consensus prevail. The literature on infection criteria was reviewed and a set of criteria were collated; a number of criteria at the time were described as subtle in nature and have undergone validation studies. This article suggests a new perspective on the clinical identification of wound infection--ie, the signs of infection are closely associated with the wound type. Infection criteria for six wound types are explored and presented. This approach is intended for consideration together with the results of an impending Delphi study that will raise awareness of this issue, promote discussion, and lead to validation of an accurate set of clinical criteria.

Delphi Technique↗

PubMed1992

Interventions related to pain.

A two-round Delphi survey was completed by pain experts to achieve consensus on 10 selected pain interventions and associated activities characteristic of each intervention. Consistently high scores were obtained by the raters for each intervention and activity, with most activities perceived as critical to the intervention. Interventions with more specific activities were rated highest by the expert judges. Expert feedback indicates the complexity of establishing a list of activities for selected interventions when dealing with pain of various types, with different causes and for different patient populations. The expert raters clearly see assessment and evaluation activities as part of the intervention strategies for each intervention. Further research is needed to validate the interventions and activities with nurse experts from varying clinical specialty areas in the practice setting.

Delphi Technique↗

PubMedDate not supplied

Current management of hospitalized community acquired pneumonia in Portugal. Consensus statements of an expert panel.

The diagnosis and treatment of Community Acquired Pneumonia (CAP) are controversial issues, without evidence of solid consensus, reflected in the proliferation of Clinical Practice Guidelines proposing a wide range of recommendations. The aim of this study was the clinical validation of five of the most widely recognized Clinical Practice Guidelines (published by the British Thoracic Society, American Thoracic Society, Infectious Diseases Society of America, European Respiratory Society and Portuguese Society of Pulmonology), in line with the real situation in Portugal, as well as an assessment of the role of macrolides in the treatment of CAP. This study adopted the Delphi method to reach consensus from a panel of 20 Portuguese experts in the treatment of CAP, 16 of which participated actively in the study. A questionnaire with all the management options recommended by the five guidelines was distributed to the experts, who reported their degree of agreement with each recommendation on a 9-point Likert scale. The opinions of the specialist panel are reported, as well as the level of consensus and degree of sufficiency of each management option. The results of this study allowed the identification of the management options receiving a high level of acceptance among Portuguese physicians, as well as the estimation of epidemiological parameters, the definition of standards of care and the identification of the most relevant characteristics for the initial selection of antibiotics for empirical therapy. Erythromycin presents disadvantages in almost all characteristics, compared to advanced generation macrolides. Among these, azithromycin meets the panel of experts preferences as to antibiotic tolerability, administration schedule and costs better than clarithromycin.

Anti-Bacterial Agents↗

PubMed2005

Estimates of disease burden due to land-snake bite in Sri Lankan hospitals.

Snake bite is a common cause of hospital admission in Sri Lanka. Despite this, there have been no countrywide studies or national estimates of disease burden due to snake bites in Sri Lankan hospitals. We assessed the disease burden due to snake bite in our hospitals and estimated the frequency of admissions due to bites by different snake species. Sri Lanka was divided into four zones based on climate and topography. Hospital morbidity and mortality data, which are available on an administrative district basis, were collated for the four zones. A survey of opinion among specialist physicians (the Delphi technique) was used to estimate the proportion of bites by different species, and requirements for anti-venom (AV) and intensive care facilities for management of snake bites in hospitals in each of the four zones. A study of hospital admissions due to snake bites in seven selected hospitals was also performed to validate the opinion survey. There was a clear difference in the incidence of hospital admissions due to snake bites in the different zones. Estimates of hospital admissions due to bites by different species also varied considerably between zones. These trends corresponded to estimates of requirements of AV and other supportive health care. Health care planning using data based on environmental information, rather than merely on political boundaries, could lead to targeted distribution of AV and intensive care requirements to manage snake bites.

Animals↗

PubMed2005

The evaluation of a formalized queue management system for coronary angiography waiting lists.

BACKGROUND: Lengthy waiting lists for coronary angiography have been described in many health care systems worldwide. The extent to which formal queue management systems may improve the prioritization and survival of patients in the angiography queue is unknown. OBJECTIVE: To prospectively evaluate the performance of a formal queue management system for patients awaiting coronary angiography in Ontario. METHODS: The coronary angiography urgency scale, a formal queue management system developed in 1993 using a modified Delphi panel, allocates recommended maximum waiting times (RMWTs) in accordance with clinical necessity. By using a provincial clinical registry, 35,617 consecutive patients referred into the coronary angiography queue between April 1, 2001, and March 31, 2002, were prospectively tracked. Cox proportional hazards models were used to examined mortality risk across urgency after adjusting for additional clinical and comorbid factors. RESULTS: Good agreement was determined in urgency ratings between scores from the coronary angiography urgency scale and implicit physician judgement, which was obtained independently at the time of the index referral (weighted kappa = 0.49). The overall mortality in the queue was 0.3% (0.47%, 0.26% and 0.13% for urgent, semiurgent and elective patients, respectively). Urgency, as specified by the coronary angiography urgency scale, was the strongest predictor of death in the queue (P<0.001). However, when patients were censored according to their RMWTs, mortality was similar across different levels of urgency. Consequently, up to 18.5 deaths per 10,000 patients could have potentially been averted had patients been triaged and undergone coronary angiography within the RMWT as specified by the coronary angiography urgency scale. CONCLUSIONS: The incorporation of the coronary angiography urgency scale as a formal queue management system may decrease mortality in the coronary angiography queue. The authors recommend its implementation in health care systems where patients experience excessive waiting time delays for coronary angiography.

Aged↗

PubMed1992

Important curriculum content for baccalaureate allied health programs: a survey of deans.

The purpose of this study was to assist deans of baccalaureate-level schools of allied health professions to come to consensus on knowledge and skills that graduates should have over and above what is required for professional accreditation and credentialing, and prerequisite or cognate courses that may be utilized to develop them. An adaptation of the Delphi method was used in 1990-1991 to survey the deans of 74 institutional members of the Association of Schools of Allied Health Professions (ASAHP) offering programs at the bachelor's degree level. Three rounds of questionnaires were completed. The study concluded that there was consensus among the 54 deans who responded to the third questionnaire that 19 items of knowledge and skill are important for allied health students, and that 14 courses are important for the development of this knowledge and these skills.

Allied Health Occupations↗

PubMed2006

[Assessment on the ability of emergency response at the county center for disease control and prevention level in flooding-prone areas].

OBJECTIVE: To establish a comprehensive assessment model on the ability of emergency response within the public health system in flooding-prone areas. METHODS: A hierarchy process theory was used to establish the initial assessing framework. Delphi method was used to screen and choose the ultimate indicators and their weights before an assessment model was set up under the 'synthetic scored method' to assess the ability of the emergency response among twenty county public health units. We then used the 'analysis of variation (ANOVA)' methodology to test the feasibility of distinguishing the ability of emergency response among different county health units and correlation analysis was used to assess the independence of indicators in the assessing model. RESULTS: A comprehensive model was then established including twenty first-class indicators and fifty-six second-class indicators and the degree of ability to emergency response with flooding of public health units was evaluated. There were five public health units having higher, ten having moderate but five with lower levels on emergency response. The assessment model was proved to be a good method in differentiating the ability of public health units, using independent indicators. CONCLUSION: The assessment model which we established seemed to be practical and reliable.

Analysis of Variance↗

PubMed2006

Item generation and pilot testing of the Comprehensive Professional Behaviours Development Log.

The purpose of this project was to generate and refine criteria for professional behaviors previously identified to be important for physical therapy practice and to develop and pilot test a new instrument, which we have called the Comprehensive Professional Behaviours Development Log (CPBDL). Items were generated from our previous work, the work of Warren May and his colleagues, a competency profile for entry-level physical therapists, our regulatory code of ethics, and an evaluation of clinical performance. A group of eight people, including recent graduates, clinical instructors and professional practice leaders, and faculty members, refined the items in two iterations using the Delphi process. The CPBDL contains nine key professional behaviors with a range of nine to 23 specific behavioral criteria for individuals to reflect on and to indicate the consistency of performance from a selection of "not at all," "sometimes," and "always" response options. Pilot testing with a group of 42 students in the final year of our entry-to-practice curriculum indicated that the criteria were clear, the measure was feasible to complete in a reasonable time frame, and there were no ceiling or floor effects. We believe that others, including health care educators and practicing professionals, might be interested in adapting the CPBDL in their own settings to enhance the professional behaviors of either students in preparation for entry to practice or clinicians wishing to demonstrate continuing competency to professional regulatory bodies.

Behavior↗

PubMed2005

Identifying performance indicators for family practice: assessing levels of consensus.

OBJECTIVE: To identify performance indicators for family practice that focus on organizational structures and clinical processes of care, to review evidence linking indicators to patient outcomes, to have providers select indicators they consider important for performance assessment, and to obtain provider views on challenges to developing a performance assessment system. DESIGN: Review of published and unpublished literature and contact with international experts resulted in a list of 131 structure and process indicators and associated evidence. This information was used in a two-round modified Delphi consensus process, which was followed by interviews with each of the 12 consensus panel members. SETTING: Ontario family practices. PARTICIPANTS: Eleven family physicians and one nurse practitioner from Ontario. MAIN OUTCOME MEASURES: Survey package with 131 indicators and associated evidence was mailed to panel members who rated each of the indicators on a Likert scale from 1 (not at all important for performance assessment) to 9 (essential for performance assessment). Interviews were conducted with panel members to discuss indicator feasibility and data sources. Consensus score and median importance score for each indicator were main outcome measures; interviews identified barriers to performance assessment. RESULTS: Fifty-one indicators achieved high consensus, 19 moderate consensus, and 38 low consensus. Clinical indicators that reached a high level of consensus were generally supported by grade A or B recommendations and level I to III evidence. Clinical indicators that achieved moderate consensus often had fair support in the literature. Low consensus was mainly associated with fair or equivocal evidence. During follow-up interviews, consensus panel members voiced frustration with inconsistencies in the evidence and practice guidelines upon which indicators are often based, and with poor transfer of patient information between health care providers. Lack of detail in patient care documentation and inconsistent documentation were mentioned frequently as threats to data quality. CONCLUSION: Despite challenges to performance measurement noted by the panel, study results support the continued development, refinement, and testing of primary care performance indicators.

Consensus↗

PubMed2006

Nursing minimum data set in the multidisciplinary electronic health record.

The development of an electronic health record requires consensus about its structure and content. The structure and content of the electronic health record refers to the standardization of views, main headings and subheadings. Views are subrecords of electronic health records that are comprised of specific data elements. Agreement on the unified structure of the electronic health record was reached by means of the consensus-based Delphi method and nominal group meetings. The structure includes general views, views by specialists, views by services, views by preventive health care and views by different health care professionals. The main headings are admission, planning, delivery and outcomes of care. In addition, there are 28 subheadings. The first experiences of the applicability of the structure will be obtained after it has been implemented in electronic health record systems by 2007. The goal is through the unified structure of electronic health records to facilitate the transfer of data between health care providers and to maintain the quality of care.

Consensus↗

PubMed2006

Consensus on diabetes management in primary care.

Diabetes management in Irish Primary Care is in the early stages of development. This study used a Delphi technique with a panel of experts working in diabetes in primary care in order to reach a consensus on its future development. There was strong agreement on the need for multidisciplinary professional advocacy to improve services for people with diabetes. The panel indicated a preference for the development of shared models of care and emphasised the importance of research, audit and professional education. The results of this study can be used by health planners to develop services in a way that reflects the experience and opinion of those working as experts in the field of primary care diabetes.

Delphi Technique↗

PubMed1991

[Future scenario's Dementia 1990-2010--various major points from the scenario report 'Care for mental health in the future'].

This paper describes major points of a study on the future of dementia in the period 1990-2010. By means of a literature review and consultation of experts in a Delphi-study exploratory scenarios and a target-setting scenario were constructed. The paper delineates the exploratory reference-scenario, which includes the most probable processes and developments according to the majority of the experts. Furthermore necessary measures and strategies are described to increase the quality of care to demented elderly in the next twenty years.

Aged↗

PubMedDate not supplied

Research priorities for burn nursing. Report of the Wound Care and Infection Control Group.

This study was designed to identify research priorities in burn nursing. The Delphi technique of sequential questionnaires was used for data collection. Ninety-four participants completed four rounds of questionnaires. One hundred one research questions were identified and prioritized according to impact on the welfare of patients with burns and impact on the profession of burn nursing. Twenty-three of these research questions concerned issues of wound care or infection control. This group of questions was further analyzed to determine priority research issues. The five most highly ranked questions in the category of wound care/infection control with regard to impact on patient welfare concerned healing of donor sites and skin grafts, wound cleansing, and the effect of pressure garments on wound healing. Similarly, the five most highly ranked questions with regard to impact on the profession of burn nursing concerned the impact of combining patients with burns and patients without burns in the same unit, healing of donor sites and skin grafts, care of the patient with burns who also has acquired immune deficiency syndrome, infection control, and dressing of the burn wound.

Algorithms↗

PubMed1991

Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine.

Increasing attention is being paid to inappropriate medication use in nursing homes. However, criteria defining the appropriate or inappropriate use of medication in this setting are not readily available and are not uniform. We used a two-round survey, based on Delphi methods, with 13 nationally recognized experts to reach consensus on explicit criteria defining the inappropriate use of medications in a nursing home population. The criteria were designed to use pharmacy data with minimal additional clinical data so that they could be applied to chart review or computerized data sets. The 30 factors agreed on by this method identify inappropriate use of such commonly used categories of medications as sedative-hypnotics, antidepressants, antipsychotics, antihypertensives, nonsteroidal anti-inflammatory agents, oral hypoglycemics, analgesics, dementia treatments, platelet inhibitors, histamine2 blockers, antibiotics, decongestants, iron supplements, muscle relaxants, gastrointestinal antispasmodics, and antiemetics. These criteria may be useful for quality assurance review, health services research, and clinical practice guidelines. The method used to establish these criteria can be used to update and expand the guidelines in the future.

Aged↗

PubMed1990

Primary health care needs of persons with physical disabilities: what are the research and service priorities?

The three-stage Delphi method was used to build consensus among experts in primary care and disability on research and service priorities in the area of primary health care for persons with physical disabilities. The specific areas of focus were (1) the high rate of rehospitalization, (2) health issues associated with aging, (3) problems of access to primary care, and (4) innovative organizational approaches to financing and providing primary care services. Issues concerning personal attendant/home health care were ranked highly in all four areas and were especially dominant in the area of rehospitalization. The issue of coordinated health care management received high ratings as well, especially in the "access" area. Other prominent issues included the effects of insurance coverage and the training of primary care providers in disability-related primary care. There was a high degree of correlation between the rankings of physicians and nonphysicians, especially in the areas of hospitalization, aging, and access. This paper examines directions in which future research and service efforts should be focused.

Aging↗

PubMedDate not supplied

Barriers to care: operationalizing the variable.

A measure was developed to operationalize the concept of barriers as the consumer's perceptions of costs or obstacles to care. First, a 12-member panel participated in a three-stage Delphi process to identify indicators of the concept. Of the 81 items generated, 54 were selected as appropriate to a well population seeking preventive care. In a survey of 800 employees of a not-for-profit organization, respondents were asked to rate each barrier indicator on a 5-point Likert scale; the response rate was 70%. Exploratory factor analysis was used to explore the construct validity of the measure. Five factors were found: Provider-Consumer Relationship, Cost, Site-Related, Inconvenience, and Fear. Confirmatory factor analysis was used to refine the indicators for each factor category, producing a scale to measure perceived barriers to secondary preventive care. Based on the factor correlations, a model of the structure of barriers is proposed, showing the relationship factor as central.

Costs and Cost Analysis↗