• Fasiha Kanwal, Alan Barkun, Ian M Gralnek, Steven M Asch, Ernst J Kuipers, Marc Bardou, Joseph Sung, Robert Enns, Lars Agreus, David Armstrong, and Brennan M R Spiegel.
• Saint Louis Veterans Administration (VA) and Saint Louis University, Saint Louis, Missouri, USA.
• Am. J. Gastroenterol. 2010 Aug 1;105(8):1710-8.

ObjectivesWith an increasing emphasis on quality in health care and recognition of inconsistencies in the management of patients with nonvariceal upper gastrointestinal hemorrhage (NVUGIH), it is critical to establish a set of explicit quality indicators (QIs) in NVUGIH.MethodsWe conducted a nine-member, multidisciplinary expert panel and followed modified Delphi methods to systematically identify a set of QIs for NVUGIH. The panel performed independent ratings of each candidate QI using a nine-point RAND appropriateness scale, then met in person and re-voted using an iterative process of discussion. The final set comprised QIs with a median RAND Appropriateness Score >or=7 and no disagreement among experts.ResultsAmong 116 candidate QIs, the panel rated 26 as valid measures of quality care. The selected QIs cover pre-endoscopy, endoscopy, and post-endoscopy care, including diagnosis, early resuscitation, risk stratification, endoscopic care, Helicobacter pylori management, and proton pump inhibitor therapy.ConclusionsWe have developed an explicit set of evidence-based QIs in NVUGIH, providing physicians and institutions with a tool to identify processes amenable to quality improvement. This tool is intended to be applicable in all institutions providing care for NVUGIH patients.

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