# Development of routine-data-compatible quality indicators for the management of osteoarthritis of the knee and hip in ambulatory care: a RAND-modified Delphi consensus process

## TL;DR

This paper develops quality indicators for managing knee and hip osteoarthritis in outpatient care using routine data, aiming to improve care before joint replacement surgery.

## Contribution

The novel contribution is the development of 12 data-compatible quality indicators for osteoarthritis management through a modified Delphi consensus process.

## Key findings

- Twelve routine-data-compatible quality indicators were developed for ambulatory osteoarthritis care.
- The indicators cover diagnostic imaging, exercise therapy, medication, TJA preconditions, and interprofessional collaboration.
- The process involved a panel of experts and stakeholders reaching consensus across three Delphi rounds.

## Abstract

High rates of total joint arthroplasty (TJA) in patients with osteoarthritis of the knee and hip in Germany have raised concerns about the insufficient use of ambulatory health care services. Quality indicators (QIs) can help assess the provision of care and identify deficits in health care delivery. To build on a preceding systematic review, we conducted a Delphi process to develop QIs that can be quantified using routine data from German statutory health insurers and used for the ambulatory management of osteoarthritis of the knee and hip before TJA.

We conducted a three-round RAND-modified Delphi consensus process consisting of an initial online questionnaire (Round 1), a virtual panel meeting with an additional online questionnaire (Round 2), and a final online questionnaire (Round 3). A panel of eight physicians, one physical therapist and one patient advocacy organisation representative evaluated QIs derived from a systematic review for relevance, clarity and feasibility. The panel also proposed additional QIs for consideration.

Following pre-selection by two non-panel physicians, 19 of the 24 QIs identified in the systematic review were included in the first Delphi round. During the panel meeting, panellists proposed six additional QIs. Ultimately, consensus was reached on twelve routine-data-compatible QIs related to diagnostic imaging, exercise therapy, medication, preconditions for TJA, and interprofessional collaboration among physicians.

The evidence- and consensus-based QIs are intended to support health care providers in monitoring and improving care processes, and may serve as a basis for identifying and addressing variation in care quality.

The online version contains supplementary material available at 10.1186/s13018-025-06127-x.