Thyroid cancer - clinical quality performance indicators: engagement document

2. Quality Performance Indicator (QPI) Development Process

The QPI development process was designed to ensure that indicators are developed in an open, transparent and timely way.

The Thyroid Cancer QPI Development Group was convened on 1st March 2023, chaired by Dr Rob Jones, Consultant Medical Oncologist, NHS Greater Glasgow and Clyde. Membership of this group includes multidisciplinary clinical representatives drawn from each region across the national network, the Scottish Cancer Network and National Services Scotland (NSS). Membership of the development group can be found in appendix 1.

2.1 Preparatory Work and Scoping

Through ‘The Scottish Thyroid Cancer Project’, national guidance was produced to supplement existing guidelines with the aim of reducing variation in practice across Scotland. Consensus Guidelines on ‘Routine Practice for Differentiated Thyroid Cancer in Scotland' were developed to be read in tandem with the existing UK National Guidance on management of thyroid cancer, published by the British Thyroid Association (BTA) in 2014. More recently, in December 2022 the National Institute of Health and Care Excellence (NICE) published the guideline on ‘Thyroid Cancer: Assessment and Management’. These informed the basis of the evidence on which QPIs for thyroid cancer were developed.

2.2 Indicator Development

The indicator development phase of the project allowed the development group to create evidence based, measurable indicators with a clear focus on what could actually make a real difference to quality of care.

Draft QPIs were then assessed by the Thyroid Cancer QPI Development Group against three criteria:

• Overall importance - does the indicator address an area of clinical importance that would significantly impact on the quality and outcome of care delivered?
• Evidence based - is the indicator based on high quality clinical evidence?
• Measurability - is the indicator measurable i.e. are there explicit requirements for data measurement and are the required data items accessible and available for collection?

A final short-list of QPIs was then agreed (see section 3), which were felt to address these criteria.

2.3 Format of the Quality Performance Indicators

QPIs are designed to be clear and measurable, based on sound clinical evidence whilst also taking into account other recognised standards and guidelines.

• Each QPI has a short title which will be utilised in reports as well as a fuller description which explains exactly what the indicator is measuring.
• This is followed by a brief overview of the evidence base and rationale which explains why the development of this indicator was important.
• The measurability specifications are then detailed; these highlight how the indicator will actually be measured in practice to allow for comparison across NHSScotland.
• Finally a target is indicated, this dictates the level which each unit should be aiming to achieve against each indicator.

In order to ensure that the chosen target levels are the most appropriate and drive continuous quality improvement as intended they are kept under review and revised as necessary, if further evidence or data becomes available.

Rather than utilising multiple exclusions, a tolerance level has been built into the QPIs. It is very difficult to accurately measure patient choice, co-morbidities and patient fitness therefore target levels have been set to account for these factors. Further detail is noted within QPIs where there are other factors which influenced the target level.

Where ‘less than’ (<) target levels have been set the rationale has been detailed within the relevant QPI. All other target levels should be interpreted as ‘greater than’ (>) levels.