title: Indicators to improve clinical quality across an integrated health care system.
abstract: OBJECTIVE
  To describe key historical and operational elements of change that may assist an organization to develop quality indicators for implementing a strategic plan to improve care, align health care improvement efforts with national directions, and examine the types of medication indicators used to assess these changes.
  
  
  METHODS
  The Baylor Health Care System (BHCS) is an integrated health care delivery organization in Dallas-Fort Worth, Texas. It includes 11 hospitals with 83 000 admissions per year and 47 primary care and senior centers with more than 500 000 visits annually.
  
  
  METHODS
  Following a charter by the BHCS Board of Trustees to develop a health care quality improvement strategic plan, BHCS undertook a system-wide effort to improve care supported by the use of clinical quality indicators.
  
  
  RESULTS
  Consistent with the direction of the US Institute of Medicine, BHCS has implemented a clinical indicator system focused on measures of health care underuse, overuse, and misuse. These indicators demonstrated the accomplishments of specific process of care improvements throughout BHCS. Despite implementing Web-enabled error reporting systems and pilot work with an adverse drug event hospital medical record abstraction tool, BHCS indicators of medication misuse continue to be in a formative stage, much like the national consensus.
  
  
  CONCLUSIONS
  Organizational, compensatory, and cultural commitments may be important for successful implementation of clinical indicator initiatives by health care systems. Using clinical indicators to establish baseline performance and to assess the effectiveness of proposed quality improvements provides quantitative and qualitative means to identify and disseminate best care practices. Although indicators to measure underuse of clinically necessary care are well established, there remains a need to achieve consensus regarding practicable medication quality indicators for overuse, misuse, and adverse drug events.
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 N. Central Expressway, Suite 1050, LB 81, Dallas, TX 75206, USA. dj.ballard@baylorhealth.edu
authors.forename: David J
authors.initials: DJ
authors.lastname: Ballard
mesh_terms: D019985:Benchmarking / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D017723:Drug Utilization Review; D006300:Health Services Misuse; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control; D008510:Medication Systems, Hospital / Q000592:standards; D019982:Organizational Case Studies; D009936:Organizational Innovation; D011314:Preventive Health Services / Q000592:standards / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D018571:Sentinel Surveillance; D013781:Texas