Guideline-based development of quality indicators for hypertensive diseases in pregnancy

Objective. Hypertensive disorders in pregnancy are one of the main causes of maternal morbidity and mortality. Internationally, several organizations have developed clinical guidelines to assist professionals and to supply patients with the best possible care. To improve the care for this group of patients, insight into the application of clinical guidelines in daily practise is needed. Valid quality indicators are necessary to estimate actual guideline adherence. In this study, we developed a set of valid guideline-based quality indicators for hypertensive diseases in pregnancy. Methods. A systematic RAND-modified Delphi method was used to develop a set of quality indicators on the basis of evidence-based guidelines and literature on hypertension and pregnancy. Experts' opinions were used to select the indicators regarding specific criteria such as efficacy, level of health gain, and potential for care improvement. Results. A representative set of 14 quality indicators was selected from 48 initial guideline recommendations. Indicators concerned both professional performance and organization of care for patients with hypertension in pregnancy. Conclusions. This study describes the systematic, stepwise method used to develop quality indicators that can be used to monitor care for hypertensive diseases in pregnancy