{
    "abstract": "Abnormal uterine bleeding (AUB) is a common women's health complaint. However, the quality of primary care (PC) management of AUB is unknown. Our objective was to develop quality indicators for Veterans Health Administration (VA) PC assessment and management of AUB.\nWe drafted candidate indicators based on comprehensive review of the scientific literature, including published consensus guidelines. Then, we convened a national panel of nine experts including PC providers, obstetrician-gynecologists, VA policy stakeholders, and quality measurement experts, and used a modified Delphi panel process. First, panelists individually rated 19 candidate indicators, using 9-point scales, on three metrics: consistency with established guidelines, importance to women's health, and reliability of measurement from VA electronic health records. Panelists then discussed the indicators. Finally, panelists re-rated revised indicators using the same metrics. Indicators were selected if final median ratings were \u22657 on each 9-point scale, without dispersion in ratings.\nEighteen indicators were selected. Three focused on assessing need for emergency care (e.g., profuse bleeding or pregnancy). Three addressed ascertaining key aspects of the medical history (e.g., endometrial cancer risk). Two addressed performing a physical examination (e.g., pelvic examination). Six addressed indications for diagnostic studies and specialty care referrals, (e.g., transvaginal ultrasound examination). Four addressed initiation of treatment and counseling (e.g., hormone therapy).\nWe developed quality indicators for PC assessment and management of AUB that span reproductive and postmenopausal life phases. Applying these indicators in VA and other health systems with integrated electronic health records can assess need for, and effects of, AUB quality improvement programs.",
    "authors": [
        {
            "affiliation": "VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, University of California Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, California. Electronic address: donna.washington@va.gov.",
            "firstname": "Donna L",
            "initials": "DL",
            "lastname": "Washington"
        },
        {
            "affiliation": "VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; RAND Corporation, Santa Monica, California.",
            "firstname": "Marjorie",
            "initials": "M",
            "lastname": "Danz"
        },
        {
            "affiliation": "VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.",
            "firstname": "LaShawnta",
            "initials": "L",
            "lastname": "Jackson"
        },
        {
            "affiliation": "VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, University of California Los Angeles (UCLA) Geffen School of Medicine, Los Angeles, California.",
            "firstname": "Kristina M",
            "initials": "KM",
            "lastname": "Cordasco"
        }
    ],
    "conclusions": null,
    "copyrights": "Published by Elsevier Inc.",
    "doi": "10.1016/j.whi.2018.11.002",
    "journal": "Women's health issues : official publication of the Jacobs Institute of Women's Health",
    "keywords": [],
    "methods": null,
    "publication_date": "2018-12-20",
    "pubmed_id": "30563732",
    "results": "Eighteen indicators were selected. Three focused on assessing need for emergency care (e.g., profuse bleeding or pregnancy). Three addressed ascertaining key aspects of the medical history (e.g., endometrial cancer risk). Two addressed performing a physical examination (e.g., pelvic examination). Six addressed indications for diagnostic studies and specialty care referrals, (e.g., transvaginal ultrasound examination). Four addressed initiation of treatment and counseling (e.g., hormone therapy).",
    "title": "Development of Quality Indicators for the Care of Women with Abnormal Uterine Bleeding by Primary Care Providers in the Veterans Health Administration.",
    "xml": "<Element 'PubmedArticle' at 0x788501d82b60>"
}