Figure 1.

Overview of the modified Delphi process for developing quality indicators (QIs) for pulmonary arterial hypertension (PAH) management in Japan. The process included a literature review and creation of QI candidates by PAH specialists from 11 centers, resulting in 36 initial QI candidates (34 from European Society of Cardiology and European Respiratory Society guidelines and two proposed QIs based on Japanese clinical practice). The Round 1 rating process involved 11 panelists, in which 35 of 36 prospective QIs met the criteria (median score ≥ 7 points). An expert panel meeting with 10 participants led to modifications in five indicators and wording revisions for 13 indicators. The Round 2 (re-)rating process confirmed all 36 QIs as meeting the criteria (median score ≥ 7 points). The final versions of the QIs were completed in both Japanese and English.