Development of a perioperative core structure and process indicator set using modified Core Outcome Measures in Effectiveness Trials (COMET) methodology and participatory approaches

BACKGROUND: Robust, patient-centred indicators are important to quality of care. We developed a core indicator set for structure and process in perioperative care using a participatory, evidence-informed approach. METHODS: We conducted a three-phase project based on the modified Core Outcome Measures in Effectiveness Trials methodology. Indicators of structure and process in perioperative care were identified from a systematic review and mapped to a 10-domain conceptual framework developed in parallel. Stakeholders, including patients, carers, and clinicians, took part in indicator refinement and prioritisation through four rounds of surveys. Quantitative analyses assessed rank stability, attrition bias, and consensus strength, whereas qualitative comments were thematically analysed. A consensus workshop and consultation were used to finalise the indicator set. RESULTS: From 657 sources in the systematic review, 615 perioperative indicators were identified (324 process, 248 structure, 43 unclear) and mapped onto the conceptual framework. Four survey ranking rounds involving more than 250 stakeholders reduced the number of indicators to 142, showing high stability (ρ=0.89; W=0.712) and increasing agreement. A consensus workshop with 26 participants produced a final set of 56 indicators (28 core and 28 desirable) that aimed to balance feasibility, impact, and patient-centredness. CONCLUSIONS: This participatory process produced a consensus-based, multidimensional core set of perioperative structure and process indicators reflecting both clinical relevance and lived experience. The indicator set is likely to be valuable in quality-related activities. Our methodology offers a potentially transferable model for developing indicator sets of structure and process.