Funding: The Centre of Research Excellence in Patient Safety is funded by the Australian Commission on Safety and Quality in Health Care and is designated as a National Health and Medical Research Council Centre of Research Excellence. This study was funded by the Australian Centre for Health Research and supported by a National Health and Medical Research Council Postdoctoral Fellowship (SME) and Health Services Research Grant no. 465129 (BC).
Measuring the quality of hospital care: an inventory of indicators
Article first published online: 23 MAR 2009
© 2009 The Authors. Journal compilation © 2009 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 39, Issue 6, pages 352–360, June 2009
How to Cite
Copnell, B., Hagger, V., Wilson, S. G., Evans, S. M., Sprivulis, P. C. and Cameron, P. A. (2009), Measuring the quality of hospital care: an inventory of indicators. Internal Medicine Journal, 39: 352–360. doi: 10.1111/j.1445-5994.2009.01961.x
Potential conflicts of interest: None.
- Issue published online: 2 JUL 2009
- Article first published online: 23 MAR 2009
- Received 3 December 2008; accepted 6 March 2009.
- quality indicator;
- health care;
- quality of health care;
- quality assurance;
Background: Development of indicators to measure health-care quality has progressed rapidly. This development has, however, rarely occurred in a systematic fashion, and some aspects of care have received more attention than others. The aim of this study is to identify and classify indicators currently in use to measure the quality of care provided by hospitals, and to identify gaps in current measurement.
Methods: A literature search was undertaken to identify indicator sets. Indicators were included if they related to hospital care and were clearly being collected and reported to an external body. A two-person independent review was undertaken to classify indicators according to aspects of care provision (structure, process or outcome), dimensions of quality (safety, effectiveness, efficiency, timeliness, patient-centredness and equity), and domain of application (hospital-wide, surgical and non-surgical clinical specialities).
Results: 383 discrete indicators were identified from 22 source organizations or projects. Of these, 27.2% were relevant hospital-wide, 26.1% to surgical patients and 46.7% to non-surgical specialities, departments or diseases. Cardiothoracic surgery, cardiology and mental health were the specialities with greatest coverage, while nine clinical specialities had fewer than three specific indicators. Processes of care were measured by 54.0% of indicators and outcomes by 38.9%. Safety and effectiveness were the domains most frequently represented, with relatively few indicators measuring the other dimensions.
Conclusion: Despite the large number of available indicators, significant gaps in measurement still exist. Development of indicators to address these gaps should be a priority. Work is also required to evaluate whether existing indicators measure what they purport to measure.