Painting by numbers: A guide for systematically developing indicators of performance at any level of health care

Perera, Roshan; Dowell, Anthony; Crampton, Peter

doi:10.1016/j.healthpol.2012.07.008

Cited by 14 publications

(29 citation statements)

References 21 publications

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“…Credible changes in clinical outcomes depend on appropriate selection of KPIs and the appropriate interpretation of information generated by their use. The latter requires consideration of both the purpose and the unique strengths and weaknesses of each KPI . An important question for our programme is how the KPIs can be used to catalyse improvements in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…The latter requires consideration of both the purpose and the unique strengths and weaknesses of each KPI. 25 An important question for our programme is how the KPIs can be used to catalyse improvements in clinical practice. The purpose of the KPI programme was to monitor and improve patient outcomes and maintain the financial viability of the Victorian ESKD programme.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of renal key performance indicators: Promoting improved clinical practice

et al. 2015

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KPI implementation has been established in Victoria for 2 years, providing performance data without additional funding. The six Victorian KPIs are measurable, relevant and modifiable, and implementation relies on enthusiasm and goodwill of physicians and nurses involved in collecting data. The KPIs require further evaluation, but adoption of a similar programme by other jurisdictions could lead to improved national outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Implementation of renal key performance indicators: Promoting improved clinical practice

et al. 2015

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“…Many quality criteria have been developed [15–18], often following the RAND Corporation/UCLA (University of California) appropriateness method [19], but other methods have also been described [20, 21]. A perfect quality measure would fully correlate with positive outcomes for each individual patient.…”

Section: Introductionmentioning

confidence: 99%

The effect of referral templates on out-patient quality of care in a hospital setting: a cluster randomized controlled trial

Wåhlberg

Valle

Malm

et al. 2017

BMC Health Serv Res

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BackgroundThe assessment of quality of care is an integral part of modern medicine. The referral represents the handing over of care from the general practitioner to the specialist. This study aimed to assess whether an improved referral could lead to improved quality of care.MethodsA cluster randomized trial with the general practitioner surgery as the clustering unit was performed. Fourteen surgeries in the area surrounding the University Hospital of North Norway Harstad were randomized stratified by town versus countryside location. The intervention consisted of implementing referral templates for new referrals in four clinical areas: dyspepsia; suspected colorectal cancer; chest pain; and confirmed or suspected chronic obstructive pulmonary disease. The control group followed standard referral practice. Quality of treatment pathway as assessed by newly developed quality indicators was used as main outcome. Secondary outcomes included subjective quality assessment, positive predictive value of referral and adequacy of prioritization. Assessment of outcomes was done at the individual level. The patients, hospital doctors and outcome assessors were blinded to the intervention status.ResultsA total of 500 patients were included, with 281 in the intervention and 219 in the control arm. From the multilevel regression model the effect of the intervention on the quality indicator score was insignificant at 1.80% (95% CI, −1.46 to 5.06, p = 0.280). No significant differences between the intervention and the control groups were seen in the secondary outcomes. Active use of the referral intervention was low, estimated at approximately 50%. There was also wide variation in outcome scoring between the different assessors.ConclusionsIn this study no measurable effect on quality of care or prioritization was revealed after implementation of referral templates at the general practitioner/hospital interface. The results were hindered by a limited uptake of the intervention at GP surgeries and inconsistencies in outcome assessment.Trial registrationThe study was registered under registration number NCT01470963 on September 5th, 2011.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2127-1) contains supplementary material, which is available to authorized users.

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“…Quality indicators provide a means for care providers, decision makers and purchasers to measure, compare and improve the quality of care (Campbell, Roland, & Buetow, 2000;. Experts agree, both in Dutch context (Beersen, Kallewaard, van Croonenborg, van Everdingen, & van Barneveld, 2007;Koolman et al, 2012), and internationally (Kötter, Blozik, & Scherer, 2012;Perera, Dowell, & Crampton, 2012;Wollersheim et al, 2007), that indicators are ideally based on a clinical guideline, or -in absence of a guideline-on the best available scientific evidence with regard to quality of care. Although quality indicators are not directly linked to the clinical literacy movement that Evidence-based Medicine (EBM) originally set out to be (Djulbegovic & Guyatt, 2017;, some have called indicators a 'branch' of EBM as they follow the same logic: clinical science can determine 'what works' and parameters based on these scientific findings can form an objective standard for provider behavior .…”

Section: Introductionmentioning

confidence: 99%

“…Although quality indicators are not directly linked to the clinical literacy movement that Evidence-based Medicine (EBM) originally set out to be (Djulbegovic & Guyatt, 2017;, some have called indicators a 'branch' of EBM as they follow the same logic: clinical science can determine 'what works' and parameters based on these scientific findings can form an objective standard for provider behavior . Quality indicators developed according to an 'evidence-based approach' (Kötter et al, 2012;Perera et al, 2012) is unacceptable and must disappear from the agenda... not because we have anything against health insurers, but because there is not a shred of evidence that this plan provides patients with better quality or accessibility" , a spokesperson for hospitals in the Northern region claimed (Bart . Others called insurers' plans "absolutely pretentious" (Joost Visser, 2014a).…”

Section: Introductionmentioning

confidence: 99%

Experts and idiots

Moes

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Second, the quote reminds us of something more fundamental: 'evidence' is, essentially, a contested concept. Evidence and expertise are often invoked to provide a neutral, rationalistic and technical underpinning of public policy, but although evidence and expertise may seem neutral, in fact, they are not. What constitutes 'evidence' and what counts as 'objective' , 'scientific' or 'expert' knowledge is a philosophical question, rooted in the Philosophy of Science. Most 20 th century philosophers of science took a normative approach to the question: providing answers as to what Porter's work on the rise of quantitative knowledge to achieve 'objectivity' in science and public life shows how public accountability and epistemic ideals were mutually constitutive in the historical setting of the 19 th century. Porter demonstrates how statistics, numerical facts and figures have become a means to achieve objectivity and public trust in modern scientific, professional and public life. 'Trust in Numbers' invites us to take a closer look at knowledge practices and to understand the forms of trust and accountability that are constituted in them. suffers an 'intelligibility deficit' (Coady, 2010, p. 110). As an example Fricker recounts the situation of Carmita Wood, who suffers sexual harassment prior to the time when we had this critical concept: 'so she cannot properly comprehend her own experience, let alone render it communicatively intelligible to others' (Fricker, 2007, p. 1). This is considered a form of injustice, because someone who cannot make him/herself understood is unable to perform social and political tasks that demand their intelligible contribution. Someone who suffers a lack of conceptual resources to make him/ insurance (for low-income and middle-income groups), and private health insurances (for those above a certain income threshold) (Helderman et al., 2014). Faced with growing budget problems in the 80s, the lack of incentives for efficiency and innovation within the Sickness Funds system raised concerns, leading to growing support for 'incentive-based reforms and a reconsideration of the role of competition' (Van de Ven & Schut, 2008). Since the 90s successive governments worked to install all conditions necessary for managed competition in the health care system. In 2006, these efforts culminated in a major market-oriented reform within the context of a social health insurance system: the Health Insurance Act (Zorgverzekeringswet, Zvw). The introduction of the Health Insurance Act entailed a transition from government regulation of social health insurance taken out of wages (Sickness Fund system) towards a system of regulated competition between private insurance companies. clinical science can determine 'what works' and parameters based on these scientific findings can form an 'objective' standard for provider behavior (Tanenbaum, 1995, 2012). The epistemic practice of EBM has become pervasive in decision-making at macro-, mesoand micro-levels of the Dutch health care arena since the 1990s (Bolt, 2...

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Painting by numbers: A guide for systematically developing indicators of performance at any level of health care

Cited by 14 publications

References 21 publications

Implementation of renal key performance indicators: Promoting improved clinical practice

Implementation of renal key performance indicators: Promoting improved clinical practice

The effect of referral templates on out-patient quality of care in a hospital setting: a cluster randomized controlled trial

Experts and idiots

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