Recommendations for quality care indicators in severe asthma multidisciplinary units in Portugal (PRECISION project): A nationwide consensus

INTRODUCTION AND OBJECTIVES: Although severe asthma multidisciplinary units (SAMUs) are increasingly important for providing comprehensive, patient-centred care, quality metrics to assess their impact remain insufficient. We aimed to develop consensus-based recommendations for key performance indicators (KPIs) for SAMUs in Portugal. MATERIAL AND METHODS: A modified three-round Delphi study was performed (May-October 2024). The scientific committee developed 54 initial statements covering seven domains: I - Referral; II - Diagnosis; III - Treatment; IV - Monitoring; V - Administrative Tasks; VI - Nursing Care; VII - Research/Training. Participants rated agreement on a 5-point Likert scale, with consensus threshold of ≥90% (round 1) and ≥85% (round 2).The level of consensus achieved was discussed by the scientific committee. RESULTS: Forty-five out of 56 invited experts completed the exercise (80.4% response rate). Round 1 achieved consensus on 28/54 statements (51.9%), mostly on treatment (70%) and monitoring (69.2%) items. Moderate consensus was found on referral (50%) and diagnosis (42.9%). In round 2, half of the remaining items ( 13/26) achieved agreement. Statements not reaching consensus were mostly from Research and Training (50%). Only one item from Diagnosis (14.3%) and one - Monitoring (7.7%) didn't achieve consensus. CONCLUSIONS: While SA experts in Portugal reached consensus on KPIs for SAMUs related to innovative treatment, monitoring and administrative tasks, challenges persist in the areas of telemedicine, research/training, nursing care and patient referral. Standardising practices, improving access to target therapies, and adapting global metrics to the local context, could provide clearer guidance for developing future SAMU quality frameworks.