The reproducibility of CLIF, a method for clinical quality indicator formalisation.

In order to be able to automatically calculate clinical quality indicators, we have proposed CLIF, a stepwise method for clinical quality indicator formalisation. Quality indicators are used for external accountability and hospital comparison. As clinical quality indicators are computed in a decentralised manner by the hospitals themselves, reproducibility of the formalisation method is essential to ensure the comparability of calculated values. Thus, we performed a case study to investigate the reproducibility of CLIF. Eight participants formalised the same sample quality indicator with the help of a web-based indicator-authoring tool that facilitates the application of CLIF. We analysed the results per step and concluded that the method itself leads to reproducible results. To further improve reproducibility, ambiguities in the indicator text must be clarified and trained experts are needed to encode clinical concepts and to specify the relations between concepts.