It is no longer sufficient for health care professionals to provide high quality health care, they must also be able to demonstrate that they are meeting and often exceeding quality targets. Quality indicators (QIs) provide a means of measuring and assessing quality, however there are advantages and disadvantages of indicator measurement. Further, the clinical perspective needs to be balanced against managerial control when developing valid, reliable, sensitive and specific QIs. While indicators do not represent a perfect measurement device, they may provide a useful tool for improving patient safety and meeting community 3 The proliferation of health care QIs comes at considerable collection and measurement cost. There is no systematic approach to the introduction of QIs and frequently little appreciation of the benefits and limitations of these measures. This review aims to provide an overview of the role of QIs in health care and discuss their uses and potential limitations.
What is quality?The US Institute of Medicine defines quality as the "degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge". 4 This definition highlights the issues involved in measuring quality of care, including the need for a specific focus on what is to be assessed, understanding the links between process and outcome, and measuring the ability of the system to keep pace with advances in treatment. Many issues surrounding quality What is known about the topic? There is increasing emphasis being placed on quality indicators to assess quality.
What does this paper add?This paper provides an overview of the advantages, disadvantages and issues associated with the development and use of quality indicators. Based on this analysis the authors conclude that many existing indicators have not been rigorously investigated as to whether they are reliable and valid in measuring quality.
What are the implications for practitioners?Health care management and policy practitioners must consider implementation of feasible quality indicators that meet clinical and management decision-making needs.