A model to assess the usefulness of performance indicators.

This paper describes the Perception-Action-Impact (PAI) model used for testing the usefulness of health care organization performance indicators, and reports preliminary data in support of this model. Two hundred and ninety six hospitals contributed 500,000 obstetrical cases, and responded to surveys to assess various aspects of indicator usefulness. Domains of interest that were assessed include relevance of the measures, whether the measures identified opportunities for improvement, whether the health care organization took any action in response to the data, health care organizational structure for data use, and methods for dissemination of the indicator data. Findings from this study provide support for the PAI model. Consequently, perceptions regarding the indicators apparently have a significant impact on the usefulness of the data. When action was taken in response to the indicator data, a positive impact on patient care processes and outcomes was the typical result. Additional research is needed in the areas of data dissemination effectiveness, and the impact of attitude change on the use of performance measures.