2 ObjectivesTo define performance indicator, criteria and standard
3 Criterion (definition) A systematically developed statement that can be used to assess the appropriateness of specific healthcare decisions, services, and outcomes (Institute of Medicine, 1992)
4 Definitions of a ‘standard’ An objective with guidance for its achievement given in the form of criteria sets which specify required resources, activities, and predicted outcomes (Royal College of Nursing, 1990)The level of care to be achieved for any particular criterion (Irvine and Irvine, 1991)The percentage of events that should comply with the criterion (Baker and Fraser, 1995)
6 Criteria structure (what you need) process (what you do) outcome of care (what you expect).
7 Structure criteria Structure criteria refer to the resources required the numbers of staff and skill mixorganisational arrangements,the provision of equipment andphysical space
8 Process criteriaProcess criteria refer to the actions and decisions takencommunication,assessment,education,investigations,prescribing,surgical and other therapeutic interventions,evaluation, anddocumentation.
9 Process criteriaProcess criteria are more sensitive measures of the quality of care, as a poor outcome does not occur every time there is an error or omission in the provision of care.the importance of process criteria is determined by the extent to which they influence outcome
10 Outcome criteriaOutcome criteria are typically measures of the physical or behavioural response to an intervention and reported health status
11 Outcome criteriaSome audits focus specifically on outcomes and collect data about the outcomes of care. This is a practical possibility when outcomes are easily measurable and occur soon after the delivery of care.If the outcomes are also of major importance to users, for example postoperative complications, the direct measurement of outcome is not only appropriate but also expected
12 Outcome criteriaWhen outcomes are used for comparative audit, adjustments may be needed for case mix, a process known as ‘risk adjustment’.
13 Developing valid criteria/ standard Based on evidenceRelated to important aspects of careMeasurable
15 Using guidelinesRecommendations from clinical practice guidelines can be used to develop criteria and standards without substantial additional work
16 Prioritising the evidence method This method of developing criteria reviews the evidence in the source guidelines or systematic reviews for each element of care identified as important in determining outcomeThe criteria that have most impact on outcome are then categorised as ‘must do’ or ‘should do’
17 RAND/UCLA appropriateness method The findings of a literature review are submitted to a panel of clinicians, chosen for their clinical expertise and professional influence, who are asked to rate the appropriateness of a set of possible indications for the particular procedure
18 Examples of criteriaNew benzodiazepine prescriptions must only be issued for short-term relief (no longer than four weeks) of severe anxiety or insomnia
20 Using levels of performance achieved in trials the levels of performance achieved in trials are helpful, but should not be regarded as uniformly achievable in unselected patient populations.
21 BenchmarkingAn organisation first identifies the areas of practice where the quality of patient care would benefit from comparison and sharing of information about the processes involved in achieving high performanceThen it compares its performance with that of its most successful ‘competitors’ and considers areas for development in the light of the comparison
22 Care pathwaysIntegrated care pathways define the expected timing and course of events in the care of a patient with a particular conditionThey describe explicitly all the expected processes of care.Care pathways are easier to introduce when there is established routine practice and little variation between users
23 Example for blood transfusion Donors should have a health check prior to donation(criterion).We would expect 100% compliance, it is mandatory for all donors(standard).