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11 The RAND appropriateness method, developed in North America, is now a core feature of the process of development of quality indicators for the UK QOF.
Furthermore, the methods for the development of quality indicators within the EC are not well defined [4].
The development of quality indicators from this first long list of 160 putative indicators in multiple domains was an iterative process.
Our study has strengths: the systematic nature of the literature search and review and the incorporation of information from studies that provided indirect evidence relevant to the development of quality indicators.
Four [9 12] reported development of quality indicators for use in headache-service delivery; 28 [13–40] (listed in Table 2) evaluated aspects of headache care quality in a variety of settings, but did not employ formal quality measures to do so.
In the European Union, an increasing emphasis is being placed on the development of specific "national plans" for rare diseases, covering areas including centres of expertise and reference networks as well as promoting initiatives such as registries and development of quality indicators for care across the rare disease field.
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The pre-publication history for this paper can be accessed here: n = number of different quality indicators regarding this type; *extent of scientific development of quality indicator: Level Ia = pre-study data indicating consistently sound psychometric properties; Iac = pre- and on-study data indicating consistently sound psychometric properties; IV = no pre- or on-study psychometric data.
Studies were included if they reported the development or application of quality indicators for headache care or evaluated other aspects of service provision for headache disorders.
Well-developed quality assurance systems currently exist in high-income countries [7, 8], where the development and use of quality indicators has led to major improvements in the standard of emergency care provided [9].
28 The RAM consists of the development and validation of quality indicators through a literature review and a two-round modified-Delphi method with a panel of experts.
However, prior to 2009 there was no published indicator testing protocol for the development and piloting of quality indicators in the UK.
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