[Developing quality indicators in hospitals: the COMPAQH project].
BACKGROUND
To select a set of quality indicators (QI) in order to test them in a panel of 36 French hospitals


METHODS
The COMPAQH (COordination for Measuring Performance and Assuring Quality in Hospitals) project is coordinated by the French National Institute for Medical Research and supported by the French Ministry of Health and the French National Evaluation and Accreditation Agency. This project has four objectives: (1) to select a set of QI -2003- (2) to implement them in 2004-2005 in a volunteer panel of hospitals (3) to compare the hospitals anonymously (4) to explore quality management implications. QI were selected with a four-step process: (1) Establishment of a list of national priorities for Quality Improvement in relation with the Ministry of Health. (2) setting up a potential list of QI regarding these priorities. The COMPAQH staff determined a preliminary set of 81 QI, based on data in the literature and evidence about the scientific soundness of quality measures and the effectiveness of methods for improving quality. (3) Evaluation of the preliminary list. Each QI was presented in a pamphlet describing its operational definition, rationale, methodology, workload and responsibility of data collection The hospital panel (representatives) ranked the 81 QI with a validated evaluation tool which contained four dimensions: Importance, Scientific acceptability, Feasibility, and Usability. (4) Development of a consensus on a final selection. Based on a structured voting process (Delphi method, two rounds), the hospital panel selected a comprehensive set of 42 QI among the 81.


RESULTS
(1) Eight national priorities were defined: pain management, continuity of care, management of nutritional disorders, Iatrogenic risks (including nosocomial infections), patient satisfaction, follow-up of practice guidelines, management of human resources, accessibility. (2) A set of 42 QI were selected: a set of 6 core QI and 7 to 18 specific QI according to the hospital type.


CONCLUSIONS
Such a set of QI provides a foundation for developing a quality measurement system in French hospitals. It requires a pragmatic view for implementing them and a coherence between the different objectives of use (internal and external use).
Grenier-Sennelier
C
C
CREGAS - INSERM U537, Hôpital de Bicêtre, 80, rue Général-Leclerc, 94276 Le Kremlin-Bicêtre Cedex.
Corriol
C
C
Daucourt
V
V
Michel
P
P
Minvielle
E
E
D000068:Accreditation; D005602:France; D006077:Government Agencies; D006292:Health Priorities; D006739:Hospital Administration / Q000592:standards*; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011635:Public Health Administration; D019984:Quality Indicators, Health Care; D012955:Societies, Medical / Q000458:organization & administration*; D017749:Total Quality Management / Q000379:methods*