Funding: Associate Professor Brand has been provided with airfare and accommodation support to present this work in Australia and New Zealand.
Measuring performance to drive improvement: development of a clinical indicator set for general medicine
Article first published online: 13 FEB 2009
© 2009 The Authors. Journal compilation © 2009 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 39, Issue 6, pages 361–369, June 2009
How to Cite
Brand, C., Lam, S. K. L., Roberts, C., Gorelik, A., Amatya, B., Smallwood, D. and Russell, D. (2009), Measuring performance to drive improvement: development of a clinical indicator set for general medicine. Internal Medicine Journal, 39: 361–369. doi: 10.1111/j.1445-5994.2009.01913.x
Potential conflicts of interest: None.
- Issue published online: 2 JUL 2009
- Article first published online: 13 FEB 2009
- Received 19 September 2008; accepted 25 November 2008.
- clinical indicator;
- general medicine;
- performance measurement;
- quality improvement;
- clinical practice guideline
Background: There are delays in implementing evidence about effective therapy into clinical practice. Clinical indicators may support implementation of guideline recommendations.
Aim: To develop and evaluate the short-term impact of a clinical indicator set for general medicine.
Methods: A set of clinical process indicators was developed using a structured process. The indicator set was implemented between January 2006 and December 2006, using strategies based on evidence about effectiveness and local contextual factors. Evaluation included a structured survey of general medical staff to assess awareness and attitudes towards the programme and qualitative assessment of barriers to implementation. Impact on documentation of adherence to clinical indicators was assessed by auditing a random sample of medical records before (2003–2005) and after (2006) implementation.
Results: Clinical indicators were developed for the following areas: venous thromboembolism, cognition, chronic heart failure, chronic obstructive pulmonary disease, diabetes, low trauma fracture, patient written care plans. The programme was well supported and incurred little burden to staff. Implementation occurred largely as planned; however, documentation of adherence to clinical indicators was variable. There was a generally positive trend over time, but for most indicators this was independent of the implementation process and may have been influenced by other system improvement activities. Failure to demonstrate a significant impact during the pilot phase is likely to have been influenced by administrative factors, especially lack of an integrative data documentation and collection process.
Conclusion: Successful implementation in phase two is likely to depend upon an effective data collection system integrated into usual care.