Metastatic bone disease: new quality performance indicator development

Samantha Downie (Lead / Corresponding author), Jennifer Cherry, Peter Hall, Alison Stillie, Matthew Moran, Cathie Sudlow, A. Hamish R. W. Simpson

    Research output: Contribution to journalArticlepeer-review

    1 Citation (Scopus)


    Objectives: Patients with metastatic bone disease (MBD) should receive the same standard of care regardless of which centre they are treated in. The aim was to develop and test a set of quality performance indicators (QPIs) to evaluate care for patients with MBD referred to orthopaedics.

    Methods: QPIs were adapted from the literature and ranked on feasibility and necessity during a modified RAND/Delphi consensus process. They were then validated and field tested in a retrospective cohort of 108 patients using indicator-specific targets set during consensus.

    Results: 2568 articles including six guidelines were reviewed. 43 quality objectives were extracted and 40 proceeded to expert consensus. After two rounds, 18 QPIs for MBD care were generated, with the following generating the highest consensus: ‘Patients with high fracture risk should receive urgent assessment’ (combined mean 6.7/7, 95% CI 6.5 to 6.8) and ‘preoperative workup should include full blood tests including group and save’ (combined mean 6.7/7, 95% CI 6.5 to 6.9). In the pilot test, targets were met for 5/18 QPIs (mean 52%, standard deviation 22%). The median deviation from projected target was −14% (interquartile range −11% to −31%, range −74% to 11%). The highest scoring QPI was ‘adults with fractures should have surgery within 7 days’ (target 80%:actual 92%).

    Conclusions: The published evidence and guidelines were adapted into a set of validated QPIs for MBD care which can be used to evaluate variation in care between centres. These QPIs should be correlated with outcome scores to determine whether they can act as predictors of outcome after surgery.
    Original languageEnglish
    Article number003025
    Number of pages13
    JournalBMJ Supportive & Palliative Care
    Early online date15 Jun 2021
    Publication statusE-pub ahead of print - 15 Jun 2021


    • Clinical decisions
    • bone
    • breast
    • chronic conditions
    • lung
    • prostate

    ASJC Scopus subject areas

    • Medicine (miscellaneous)
    • Oncology(nursing)
    • Medical–Surgical


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