Development of delivery indicators and delivery enablers for cardiovascular disease in the UK: a modified Delphi study.

Standards to define and measure quality in healthcare for cardiovascular disease risk reduction and secondary prevention are available, but there is a paucity of indicators that could serve as facilitators of structural change at a system level. This research study aimed to develop a range of delivery indicators to help cardiac clinical networks assess delivery of and progress towards cardiovascular disease objectives. This study used an adapted version of the European Society of Cardiology's four-step process for the development of quality indicators. The four steps in this study were as follows: identify critical factors of enablement, construct a list of candidate indicators, select a final set of indicators and assess availability of national data for each indicator. In this iterative process, a core project group of six members was supported by a wider review group of 21 people from the National Health Service (NHS) clinical and management personnel database. The core project group identified six relevant cardiovascular disease priorities in the NHS Long Term Plan and used an iterative process to identify 21 critical factors that impact on their implementation. A total of 57 potential indicators that could be measures of implementation were developed. The core project group agreed on a set of 38 candidate indicators that were circulated to the review group for rating. Based on these scores, the core project group excluded 5 indicators to arrive at a final set of 33 delivery indicators. National datasets were available for 22 of the final indicators, which were designated as delivery indicators. The remaining 11, for which national datasets were not available but locally available datasets could be used, were designated as delivery enablers. The suite of delivery indicators and delivery enablers for cardiovascular disease could allow a more focused evaluation of factors that impact on delivery of healthcare for cardiovascular disease.

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Déclaration de conflit d'intérêts

Competing interests: CG, AB, HW and HHG declared payments from Bayer for involvement in the programme. In the past 36 months CG: grants and contracts—Alan Turing Institute, British Heart Foundation, National Institute for Health Research, Horizon 2020, Abbott Diabetes, Bristol Myers Squibb and the European Society of Cardiology; consulting fees and/or honoraria—AI Nexus, AstraZeneca, Amgen, Bayer, Bristol Myers Squibb, Boehrinher-Ingleheim, Boston Scientific, CardioMatics, Chiesi, Daiichi Sankyo, GPRI Research B.V., Menarini, Novartis, Raisio Group, iRhythm, Organon, Wondr Medical and Zydus; support for attending meetings—AstraZeneca; data safety monitoring/advisory boards—DANBLCOK trial, TARGET CTCA trial; leadership roles in boards and societies—EHJ Quality of Care and Clinical Outcomes (Deputy Editor), NICE Indicator Advisory Committee; ESC Quality Indicator Committee (Chair); stock/stock options—CardioMatics; receipt of equipment, materials, etc—Kosmos device. AB: consulting fees and honoraria—Amarin, Astra Zeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Lilly, Novartis, Novo Nordisk and Pfizer; data safety monitoring/advisory boards—Daiichi Sankyo’s clinical trial steering group; leadership roles in boards and societies—Jain Health Initiative (Co-founder (unpaid)), UK Research and Development Leaders Clinical Group (Co-chair (unpaid)). HW: grants and contracts—AstraZeneca and Daiichi Sankyo; consulting fees and/or honoraria—Amgen, Daiichi Sankyo, Novartis and Viatris; leadership roles in boards and societies—Primary Care Cardiovascular Society (Secretary [unpaid]). HHG: consulting fees—Edwards Lifesciences, Heart Valve Voice, Pfizer Plc, ECHO-IQ, GEN inCode Plc; support for attending meetings—Edwards Lifesciences, ECHO-IQ; leadership roles in boards and societies—GEN inCode Plc (non-executive director); stock/stock options—GEN inCode Plc.