Selecting clinical outcome indicators for monitoring quality of care

Clinical outcome indicators are used to identify opportunities for improvement in patient care processes. This paper focuses on issues specific to the selection of clinical outcome indicators for use in assessing performance within and between hospitals. The issues and examples are based on the experiences of a university research team that worked in collaboration with a group of teaching hospitals to develop and monitor clinical outcome indicators. Four sets of issues are discussed: the intended use, and end users of indicator information; aspects of indicator validity; data quality; and dissemination and use of indicator information. Recommendations are made that apply to individual hospitals, groups of hospitals and health care systems.