The development of electronic health record-extractable quality indicators for osteoporosis in primary care: A rand-modified Delphi method.

Background: Osteoporosis is a common chronic condition and a cause of morbidity and mortality worldwide. Currently, osteoporosis is under-diagnosed and under-treated. There is an important role for the general practitioner (GP) in the prevention and management of this condition. The electronic health record (EHR) can be used to effectively pinpoint at-risk patients and enhance the quality of care provided to those suffering from osteoporosis. This study aims to develop evidence-based and EHR-extractable quality indicators (QIs).

Methods: The RAND/UCLA- modified Delphi method was used. After an extensive literature search, recommendations were retrieved from the selected evidence-based guidelines and included in a questionnaire if they met the 'SMART'-criteria (specific, measurable, acceptable, realistic and time-related). Next, an expert panel (8 general practitioners, 2 patients, a geriatrician, a rheumatologist and an EHR specialist) was formed and asked to grade the selected recommendations individually. A consensus meeting was hosted to discuss the results. After their final appraisal, a set of quality indicators was developed out of the included recommendations.

Results: Out of 11 evidence-based guidelines 478 recommendations were retrieved. After applying the 'SMART' criteria, 38 recommendations were presented to the panel of experts. After the written questionnaire round and the consensus meeting 25 recommendations were included. Twenty recommendations remained after final appraisal and were converted into 34 quality indicators of which 13 are currently extractable out of the electronic health record in Belgium.

Conclusion: This study generated 34 evidence-based quality indicators for osteoporosis in primary care. This set enables general practitioners to measure and enhance the quality of care for osteoporosis patients through automated audit and feedback.