Table 1 Multistep process of developing a list of 40 potential quality measures for the care of transgender patients

1.

Initial review of Clinical Practice Guidelines (CPGs)

Four reviewers, each made a complete list of all potential quality measures (QMs) contained in any of 8 CPGs

2.

Combining all four sheets into a single document, preserving all versions

One combined document, preserving all versions as recorded by four reviewers, allowing side-by-side comparisons of language: 120 potential QMs

3.

Combining versions into a single QM for each item

One combined document with a single proposed version of each potential QM

4.

Group discussions and refinement

One combined document with a single approved version of each potential QM – as agreed by all 4 reviewers by group consensus: 80 potential QMs

5.

Individual priority rankings

Each reviewer ranks all 80 potential QMs in terms of relative priority based on importance, feasibility of measurement, and other considerations

6.

Group priority rankings

Group discussion of priority rankings leads to a consensus-approved list of 40 potential QMs, ranked in order of priority

7.

Meetings with data analyst

Operationalization of all 40 potential QMs, with logic model, numerator and denominator, and codes to be used (diagnosis codes, medication lists, etc.)

8.

Convening of the Technical Expert Panel

Evaluation of our candidate QMs and recommendations of which of the measures might be best suited to serve as QMs