Recommendations for quality care indicators in severe asthma multidisciplinary units in Portugal (PRECISION project): A nationwide consensus.
Consensus on key performance indicators for severe asthma care in Portugal was achieved, particularly in treatment and monitoring, but challenges remain in research, training, and telemedicine.
Where it sits
this study against the rest of the cjc-1295 corpusSummary and findings
A modified three-round Delphi study was conducted to develop consensus-based recommendations for key performance indicators for severe asthma multidisciplinary units in Portugal. Forty-five out of 56 invited experts participated, achieving consensus on 28 out of 54 initial statements. Consensus was highest for treatment and monitoring domains.
Abstract
<h4>Introduction and objectives</h4>Although severe asthma multidisciplinary units (SAMUs) are increasingly important for providing comprehensive, patient-centred care, quality metrics to assess their impact remain insufficient. We aimed to develop consensus-based recommendations for key performance indicators (KPIs) for SAMUs in Portugal.<h4>Material and methods</h4>A modified three-round Delphi study was performed (May-October 2024). The scientific committee developed 54 initial statements covering seven domains: I - Referral; II - Diagnosis; III - Treatment; IV - Monitoring; V - Administrative Tasks; VI - Nursing Care; VII - Research/Training. Participants rated agreement on a 5-point Likert scale, with consensus threshold of ≥90% (round 1) and ≥85% (round 2).The level of consensus achieved was discussed by the scientific committee.<h4>Results</h4>Forty-five out of 56 invited experts completed the exercise (80.4% response rate). Round 1 achieved consensus on 28/54 statements (51.9%), mostly on treatment (70%) and monitoring (69.2%) items. Moderate consensus was found on referral (50%) and diagnosis (42.9%). In round 2, half of the remaining items ( 13/26) achieved agreement. Statements not reaching consensus were mostly from Research and Training (50%). Only one item from Diagnosis (14.3%) and one - Monitoring (7.7%) didn't achieve consensus.<h4>Conclusions</h4>While SA experts in Portugal reached consensus on KPIs for SAMUs related to innovative treatment, monitoring and administrative tasks, challenges persist in the areas of telemedicine, research/training, nursing care and patient referral. Standardising practices, improving access to target therapies, and adapting global metrics to the local context, could provide clearer guidance for developing future SAMU quality frameworks.
Background
Severe asthma multidisciplinary units (SAMUs) are crucial for delivering comprehensive care, yet there is a lack of standardized quality metrics to evaluate their effectiveness. This study addresses the need for consensus-based key performance indicators (KPIs) to guide SAMUs in Portugal. Establishing these KPIs is important for improving patient outcomes and care quality in severe asthma management.
Methods
The study employed a modified three-round Delphi method conducted from May to October 2024. A scientific committee developed 54 initial statements across seven domains. Experts rated their agreement on a 5-point Likert scale, with a consensus threshold set at ≥90% for round 1 and ≥85% for round 2. Forty-five out of 56 invited experts participated, resulting in an 80.4% response rate.
Results
Consensus was achieved on 28 out of 54 statements, representing 51.9% of the total. The highest consensus was in the treatment domain at 70%, followed by monitoring at 69.2%. Moderate consensus was found in referral (50%) and diagnosis (42.9%). In the second round, 13 out of 26 remaining items reached agreement. Areas such as research and training, telemedicine, nursing care, and patient referral faced challenges in achieving consensus.
Interpretation
The study highlights the areas of treatment and monitoring as having strong consensus among experts, suggesting these domains are well-understood and prioritized in SAMUs. However, the lack of consensus in research, training, and telemedicine indicates ongoing challenges in these areas. The findings suggest a need for further refinement and adaptation of KPIs to local contexts to enhance the quality of care in SAMUs.
Key findings
- 45/56 experts completed the exercise (80.4% response rate).
- Consensus achieved on 28/54 statements (51.9%).
- 70% consensus on treatment items.
- 69.2% consensus on monitoring items.
- 50% consensus on referral items.
- 42.9% consensus on diagnosis items.
Limitations
- Reliance on expert opinion.
- Consensus may not reflect practical implementation.
- Limited to Portuguese context.
- Focus on consensus rather than empirical validation.