Using clinical indicators in a quality improvement programme targeting cardiac care

Hickey, Annabel, Scott, Ian, Denaro, Charles, Stewart, Neil, Bennett, Cameron and Theile, Therese (2004) Using clinical indicators in a quality improvement programme targeting cardiac care. International Journal For Quality In Health Care, 16 Supplement 1: I11-I25. doi:10.1093/intqhc/mzh032

Author Hickey, Annabel
Scott, Ian
Denaro, Charles
Stewart, Neil
Bennett, Cameron
Theile, Therese
Title Using clinical indicators in a quality improvement programme targeting cardiac care
Journal name International Journal For Quality In Health Care   Check publisher's open access policy
ISSN 1353-4505
Publication date 2004
Sub-type Article (original research)
DOI 10.1093/intqhc/mzh032
Volume 16
Issue Supplement 1
Start page I11
End page I25
Total pages 15
Editor R. H. Palmer
Place of publication USA
Publisher Oxford University Press
Collection year 2004
Language eng
Subject C1
321208 Primary Health Care
730217 Health status (e.g. indicators of well-being)
Abstract Rationale. The Brisbane Cardiac Consortium, a quality improvement collaboration of clinicians from three hospitals and five divisions of general practice, developed and reported clinical indicators as measures of the quality of care received by patients with acute coronary syndromes or congestive heart failure. Development of indicators. An expert panel derived indicators that measured gaps between evidence and practice. Data collected from hospital records and general practice heart-check forms were used to calculate process and outcome indicators for each condition. Our indicators were reliable (kappa scores 0.7-1.0) and widely accepted by clinicians as having face validity. Independent review of indicator-failed, in-hospital cases revealed that, for 27 of 28 process indicators, clinically legitimate reasons for withholding specific interventions were found in <5% of cases. Implementation and results. Indicators were reported every 6 months in hospitals and every 10 months in general practice. To stimulate practice change, we fed back indicators in conjunction with an education programme, and provided, when requested, customized analyses to different user groups. Significant improvement was seen in 17 of 40 process indicators over the course of the project. Lessons learned and future plans. Lessons learnt included the need to: (i) ensure brevity and clarity of feedback formats; (ii) liberalize patient eligibility criteria for interventions in order to maximize sample size; (iii) limit the number of data items; (iv) balance effort of indicator validation with need for timely feedback; (v) utilize more economical methods of data collection and entry such as scannable forms; and (vi) minimize the burden of data verification and changes to indicator definitions. Indicator measurement is being continued and expanded to other public hospitals in the state, while divisions of general practice are exploring lower-cost methods of ongoing clinical audit. Conclusion. Use of clinical indicators succeeded in supporting clinicians to monitor practice standards and to realize change in systems of care and clinician behaviour.
Keyword Health Care Sciences & Services
Health Policy & Services
Clinical Indicators
Performance Measures
Quality Improvement
Acute Myocardial-infarction
Practice Guidelines
Improving Quality
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2005 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 11 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 22 times in Scopus Article | Citations
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Created: Wed, 15 Aug 2007, 03:32:06 EST