Hospital quality indicators: a systematic review.

PURPOSE The purpose of this paper is to identify and describe hospital quality indicators, classifying them according to Donabedian's structure, process and outcome model and in specific domains (quality, safety, infection and mortality) in two care divisions: inpatient and emergency services. DESIGN/METHODOLOGY/APPROACH A systematic review identified hospital clinical indicators. Two independent investigators evaluated 70 articles/documents located in electronic databases and nine documents from the grey literature, 35 were included in the systematic review. FINDINGS In total, 248 hospital-based indicators were classified as infection, safety, quality and mortality domains. Only 10.2 percent were identified in more than one article/document and 47 percent showed how they were calculated/obtained. Although there are scientific papers on developing, validating and hospital indicator assessment, most indicators were obtained from technical reports, government publications or health professional associations. RESEARCH LIMITATIONS/IMPLICATIONS This review identified several hospital structure, process and outcome quality indicators, which are used by different national and international groups in both research and clinical practice. Comparing performance between healthcare organizations was difficult. Common clinical care standard indicators used by different networks, programs and institutions are essential to hospital quality benchmarking. ORIGINALITY/VALUE To the authors' knowledge, this is the first systematic review to identify and describe hospital quality indicators after a comprehensive search in MEDLINE/PubMed, etc., and the grey literature, aiming to identify as many indicators as possible. Few studies evaluate the indicators, and most are found only in the grey literature, and have been published mostly by government agencies. Documents published in scientific journals usually refer to a specific indicator or to constructing an indicator. However, indicators most commonly found are not supported by reliability or validity studies.

[1]  J. Busari.  Comparative analysis of quality assurance in health care delivery and higher medical education , 2012, Advances in medical education and practice.

[2]  Preliminary report of data collection in hospital quality assurance programs--a project of the Association of Hospitals of the Czech Republic. , 1996, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[3]  D. Schwappach,et al.  'New perspectives on well-known issues': patients' experiences and perceptions of safety in Swiss hospitals. , 2011, Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen.

[4]  N. Klazinga,et al.  Differentiating between hospitals according to the “maturity” of quality improvement systems: a new classification scheme in a sample of European hospitals , 2009, Quality & Safety in Health Care.

[5]  S. Goodacre,et al.  Evaluation of the DAVROS (Development And Validation of Risk-adjusted Outcomes for Systems of emergency care) risk-adjustment model as a quality indicator for healthcare , 2013, Emergency Medicine Journal.

[6]  R. Suñol,et al.  Cross-border care and healthcare quality improvement in Europe: the MARQuIS research project , 2009, Quality & Safety in Health Care.

[7]  Pedido DE Esclarecimento.  AGÊNCIA NACIONAL DE SAÚDE SUPLEMENTAR , 2016 .

[8]  M. Best,et al.  Avedis Donabedian: father of quality assurance and poet , 2004, Quality and Safety in Health Care.

[9]  O. Miró,et al.  Evaluación del impacto en la calidad asistencial y análisis coste-efectividad de la reforma de un servicio de urgencias de medicina , 2001 .

[10]  P. Lindenauer,et al.  Variation in Diagnostic Coding of Patients With Pneumonia and Its Association With Hospital Risk-Standardized Mortality Rates , 2014, Annals of Internal Medicine.

[11]  W. Chiu,et al.  Development and implementation of a nationwide health care quality indicator system in Taiwan. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[12]  A Donabedian,et al.  The seven pillars of quality. , 1990, Archives of pathology & laboratory medicine.

[13]  E. Daily.  Sound Principles of Administration , 1949 .

[14]  S. Pocock,et al.  Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration , 2007, Epidemiology.

[15]  Jukka Takala,et al.  Risk assessment in the first fifteen minutes: a prospective cohort study of a simple physiological scoring system in the emergency department , 2011, Critical care.

[16]  J. Roca,et al.  Indicadores de calidad en el enfermo crítico , 2008 .

[17]  Matthew H Samore,et al.  Developing Indicators of Inpatient Adverse Drug Events Through Nonlinear Analysis Using Administrative Data , 2007, Medical care.

[18]  Susumu Kunisawa,et al.  Development of a risk-adjusted in-hospital mortality prediction model for community-acquired pneumonia: a retrospective analysis using a Japanese administrative database , 2014, BMC Pulmonary Medicine.

[19]  Patarapan Odton,et al.  District-level variations in the quality of mortality data in Thailand. , 2011 .

[20]  V. Allareddy,et al.  Outcomes of Acute Chest Syndrome in Adult Patients with Sickle Cell Disease: Predictors of Mortality , 2014, PloS one.

[21]  C. Shu,et al.  Implementation of a seven-day hospitalist program to improve the outcomes of the weekend admission: A retrospective before-after study in Taiwan , 2018, PloS one.

[22]  Oliver Groene,et al.  Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety? , 2011, BMC health services research.

[23]  M. Klompas.  Ventilator-associated events surveillance: a patient safety opportunity , 2013, Current opinion in critical care.

[24]  Diederick E Grobbee,et al.  Reduced risk of surgical site infections through surveillance in a network. , 2006, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[25]  W. Baine,et al.  The Agency for Healthcare Research and Quality , 2006, Italian Journal of Public Health.

[26]  A. Donabedian.  Evaluating the quality of medical care. 1966. , 1966, The Milbank quarterly.

[27]  D. Ost,et al.  Managing infection in the critical care unit: how can infection control make the ICU safe? , 2005, Critical care clinics.

[28]  Keseteberhan Admasu,et al.  Indicators for availability, utilization, and quality of emergency obstetric care in Ethiopia, 2008 , 2011, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[29]  M. Carberry,et al.  A prospective audit of a nurse independent prescribing within critical care. , 2013, Nursing in critical care.

[30]  Lindsay Yoo,et al.  Identification of medication safety indicators in acute care settings for public reporting in Ontario. , 2010, Healthcare quarterly.

[31]  Timothy J. Vogus,et al.  Safety in Numbers: The Development of Leapfrog’s Composite Patient Safety Score for U.S. Hospitals , 2014, Journal of patient safety.

[32]  P. Shekelle,et al.  Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement , 2015, Systematic Reviews.

[33]  L. Leach,et al.  Improving Patient Safety to Reduce Preventable Deaths: The Case of a California Safety Net Hospital , 2012, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[34]  J. Ioannidis,et al.  Patient Safety Strategies Targeted at Diagnostic Errors , 2013 .

[35]  Esmaeil Mohammad Nejad,et al.  Journal of Medical Ethics and History of Medicine Medication errors of nurses in the emergency department , 2013 .

[36]  Kelvin A. Baggett,et al.  Promoting quality: the health-care organization from a management perspective. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[37]  Jeremiah T. Martin,et al.  Identification of patients with postoperative complications who are at risk for failure to rescue. , 2014, JAMA surgery.