Developing evidence-based clinical indicators: a state of the art methods primer.

OBJECTIVE: To describe steps in developing and testing clinical indicators based on state of the art methods in previous literature and experience in the Danish National Indicator Project. ANALYSIS: The development process includes a planning phase, where the clinical area to be evaluated is chosen and the measurement team selected and organized. The planning phase is followed by a development phase where clinical indicators are prioritized and selected by the measurement team on the basis of documentation and knowledge from the scientific literature. When clinical indicators have been selected, specific measure specifications should be designed, including inclusion and exclusion criteria for the target population, description of a risk adjustment strategy, identification of data sources, description of data collection procedures, and an analytical plan for data analyses. Before clinical indicators are implemented they should be tested for reliability and validity. Preliminary tests may identify areas requiring further modifications and specifications of the indicators.
CONCLUSION: Using clinical indicators for quality assessment represents an important approach to documenting the quality of care. Consumers of indicator information (clinicians, administrators, purchasers, regulators, and patients) need reliable and valid information for benchmarking, making judgments, and determining priorities, accountability and quality improvement. This underlines the fact that clinical indicators must be developed and tested with scientific rigor in a transparent process.