{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T04:06:17Z","timestamp":1774670777953,"version":"3.50.1"},"reference-count":38,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T00:00:00Z","timestamp":1615766400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The management of achalasia has improved due to diagnostic and therapeutic innovations. However, variability in care delivery remains and no established measures defining quality of care for this population exist. We aimed to use formal methodology to establish quality indicators for achalasia patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Quality indicator concepts were identified from the literature, consensus guidelines and clinical experts. Using RAND\/University of California, Los Angeles (UCLA) Appropriateness Method, experts in achalasia independently ranked proposed concepts in a two\u2010round modified Delphi process based on 1) importance, 2) scientific acceptability, 3) usability, and 4) feasibility. Highly valid measures required strict agreement (\u2267 80% of panelists) in the range of 7\u20139 for across all four categories.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>There were 17 experts who rated 26 proposed quality indicator topics. In round one, 2 (8%) quality measures were rated valid. In round two, 19 measures were modified based on panel suggestions, and experts rated 10 (53%) of these measures as valid, resulting in a total of 12 quality indicators. Two measures pertained to patient education and five to diagnosis, including discussing treatment options with risk and benefits and using the most recent version of the Chicago Classification to define achalasia phenotypes, respectively. Other indicators pertained to treatment options, such as the use of botulinum toxin for those not considered surgical candidates and management of reflux following achalasia treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions &amp; Inferences<\/jats:title><jats:p>Using a robust methodology, achalasia quality indicators were identified, which can form the basis for establishing quality gaps and generating fully specified quality measures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14118","type":"journal-article","created":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T12:35:43Z","timestamp":1615811743000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Development of quality indicators for the diagnosis and management of achalasia"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8950-8916","authenticated-orcid":false,"given":"Afrin N.","family":"Kamal","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priya","family":"Kathpalia","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of California\u2010San Francisco San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fouad","family":"Otaki","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Oregon Health and Science University Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert J","family":"Bredenoord","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Amsterdam University Medical Centre Amsterdam the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald O.","family":"Castell","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John O.","family":"Clarke","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary W.","family":"Falk","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4807-3052","authenticated-orcid":false,"given":"Ronnie","family":"Fass","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Department of Medicine The MetroHealth Medical Center and Case Western Reserve Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3388-0660","authenticated-orcid":false,"given":"C.","family":"Prakash Gyawali","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter J","family":"Kahrilas","sequence":"additional","affiliation":[{"name":"Department of Medicine Feinberg School of Medicine Northwestern University Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip O.","family":"Katz","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Weill Cornell School of Medicine New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Katzka","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Mayo Clinic Rochester Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John E.","family":"Pandolfino","sequence":"additional","affiliation":[{"name":"Department of Medicine Feinberg School of Medicine Northwestern University Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6918-9479","authenticated-orcid":false,"given":"Roberto","family":"Penagini","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology and Transplantation Universit\u00e0 degli Studi of Milan Milan Italy"},{"name":"Gastroenterology and Endoscopy Unit Fondazione IRCCS C\u00e0 Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel E.","family":"Richter","sequence":"additional","affiliation":[{"name":"Division of Digestive Diseases &amp; 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