Quality indicators for pulmonary rehabilitation programs in Canada: A Canadian Thoracic Society expert working group report

RATIONALE: Delivery of pulmonary rehabilitation (PR) varies widely across Canada. There is a need for evidence-based quality indicators (QI) that can be used to identify variations in the quality of PR with the aim of improving health outcomes.OBJECTIVES: To use an evidence-based, systematic process to develop QI that addresses the process, structure and outcomes of PR.METHODS: The development process was based on the modified RAND Appropriateness Method that included a systematic review of the literature to identify candidate QI and refinement of these QI by a Working Group before they were sent to a Delphi panel. Panel members rated the importance, scientific soundness, reliability, and feasibility of each candidate using an electronic survey. The results of the survey were distributed to panelists who deliberated by teleconference prior their re-rating the candidate QI.RESULTS: The literature review identified 5490 titles and abstracts. A total of 1653 articles were retained after initial screening. After full text screening, 190 articles remained and were used to generate 90 candidate QI. The Delphi panel identified 56 QI: 19 structural, 29 process, 8 outcome. The Working Group distilled these to a shorter list of 14 core QI that defined the minimal requirements for PR.CONCLUSIONS: This process resulted in a comprehensive set of 56 QI and a shorter list of 14 core QI that can be used for evaluation and feedback to improve PR and patient outcomes. Future research to determine standards for the QI will support the development and assessment of strategies to improve PR.