In order for this CPG to reach health care professionals in the NHS, its dissemination will be carried out by means of the GuíaSalud Catalogue (www.guiasalud.es ) and CAHTA’s website (www.aatrm.net ).

Once the national dissemination Plan within the general framework of GuíaSalud has been completed, the guide’s working group and CAHTA will perform further dissemination activities that are deemed appropriate. The CPG consists of three versions for health care professionals: the full version, the summary and the quick version. The first two include information for patients (Annex 3 ).

The CPG is edited electronically and is available on the GuíaSalud and CAHTA websites. The summarised and quick versions are also in book and leaflet form, respectively. The book contains the CD-ROM of all versions.

The measure of adherence or implementation of the CPG’s recommendations by means of monitoring and/or auditing can improve its use. The manual of the AGREE instrument addresses the importance of elaborating indicators, item 21 of the “applicability” dimension tackling this issue⁴⁵. Hence, a CPG must offer a list of clear quantifiable criteria or quality indicators that derive from the key recommendations in the guide. The most well known and widely used indicator classification system in this guide is the one pertaining to Donabedian⁴¹³, which classifies indicators into: structure, process and outcome. In order to determine and assess the performance of the most important recommendations, the assessment of certain intervening process variables and the most relevant clinical outcomes is suggested.

In the clinical assessment of eating disorders it is recommended to measure key aspects related with quality for which certain indicators are initially proposed due to their validity, reliability and feasibility at different levels of care (primary care and specialised care).

Table 1 describes the 11 proposed indicators according to clinical area, type of indicator, the dimension of quality they address and the care level where they may be applied. It is important to borne in mind that, in practice, available indicators are not perfect and constitute an approximation of a real situation. Their objective is to provide useful information to facilitate decision-making. They are quantitative measures, which, if obtained periodically, enable analysis of their evolution over time (monitoring)¹.

Some of the indicators included in the Mental Health Strategy of the NHS (Quality Plan)⁴¹⁴ are common to eating disorders. Therefore, some of the indicators proposed are common to those included in the above-mentioned plan. Others have been adopted from the Contract Programme of the Regional Ministry of Andalusia/Andalusian Health Service⁴¹⁵ and the NICE CPG³⁰. Additionally, the working group has proposed others.

Table 1. Proposed indicators

Area	Type of indicator	Name of the indicator (standard)	Quality dimension	Health care level susceptible to application
				1	2	3
Referral	Process	Proportion of patients with eating disorders who have been adequately referred to a specialised care level (See Annex 2.10.)	Adequacy	X
Referral	Process	Proportion of patients with eating disorders who have been adequately referred with emergency criteria (See Annex 2.10.)	Adequacy	X	X
Referral	Process	Average time elapsed between hospital discharge and the first outpatient (adult or children MHC) or day care follow-up visit (standard <15 days)	Continuity of care	X	X
Diagnosis	Outcome	Proportion of patients who receive diagnostic confirmation within two months of the first consultation. (see Annex 2.10.)	Adequacy/ Resolution	X	X	X
Treatment	Process	Proportion of patients diagnosed with an eating disorder who remain in treatment 6 or more months (standard >70%)	Adherence to treatment	X	X	X
Follow-up	Process	Proportion of patients diagnosed with an eating disorder during outpatient monitoring in day care or in the adult or children MHC who are discharged based on the number of months of follow-up (standard >60%)	Effectiveness/ Resolution	X	X
Follow-up	Process	Number of interviews with family members in relation to visits for patients diagnosed with an eating disorder (standard 1/month)	Integral care	X	X	X
Follow-up	Outcome	Percentage of readmissions to the general hospital at 3, 6, 9 and 12 months. (See Annex 2.10.)	Effectiveness/ Continuity of care		X	X
Diagnosis	Outcome	Proportion of patients seen with an eating disorder diagnosis in PC, adult or children MHC, day hospital and general hospital. (see Annex 2.10.)	Disease management	X	X	X
Integral care	Outcome	Satisfaction index of patients and family members by the end of treatment (see Annex 2.10.)	Satisfaction	X	X	X
Integral care	Outcome	Number of complaints (standard <5%)	Satisfaction	X	X	X

In Annex 2.10. some of the indicators proposed by this guide’s working group are described. The authors did not intend to design a comprehensive and detailed assessment that entails the use of all proposed indicators. Quite the opposite, the aim is to provide clinicians and managers who may be interested with a tool that can be useful in the specific design of care assessment.

Those in charge of assessing the impact of the CPG and management of patients with eating disorders will have to choose the most appropriate sources of information, as well as the most convenient time frame that each indicator refers to (in some, however, both aspects are established). The standard use is provided for some, but in others it is yet to be determined.