Selecting, developing, and evaluating indicators

A process for selecting and evaluating indicators for use in monitoring the quality of patient care is described. An indicator is a quantitative measure that provides information and reveals ways in which care could be improved. It is a specific set of conditions whose presence signals that the care being provided should be examined. A sample medication-use outcome indicator is discussed to illustrate the steps of indicator evaluation in a paradigm proposed by the National Demonstration Project on Quality Improvement in Health Care. Indicators must be selected according to the needs of the institution: the frequency with which the set of conditions is likely to occur, the risk involved, and the institution's goals and capabilities. Documented data on the indicator must exist and must be adequate for evaluation of care. Analysis and interpretation of the data and a plan for using the information are discussed. For the use of indicators to succeed in improving the quality of care, the total institution must be committed to the process. Pharmacy quality assurance efforts need to move from evaluation of the use of specific drugs (i.e., focus on the product) to continuous measuring, monitoring, and quality improvement.