National audit of continence care: laying the foundation.
BACKGROUND
National audit provides a basis for establishing performance against national standards, benchmarking against other service providers and improving standards of care. For effective audit, clinical indicators are required that are valid, feasible to apply and reliable. This study describes the methods used to develop clinical indicators of continence care in preparation for a national audit.


OBJECTIVE
To describe the methods used to develop and test clinical indicators of continence care with regard to validity, feasibility and reliability.


METHODS
A multidisciplinary working group developed clinical indicators that measured the structure, process and outcome of care as well as case-mix variables. Literature searching, consensus workshops and a Delphi process were used to develop the indicators. The indicators were tested in 15 secondary care sites, 15 primary care sites and 15 long-term care settings.


RESULTS
The process of development produced indicators that received a high degree of consensus within the Delphi process. Testing of the indicators demonstrated an internal reliability of 0.7 and an external reliability of 0.6. Data collection required significant investment in terms of staff time and training.


CONCLUSIONS
The method used produced indicators that achieved a high degree of acceptance from health care professionals. The reliability of data collection was high for this audit and was similar to the level seen in other successful national audits. Data collection for the indicators was feasible to collect, however, issues of time and staffing were identified as limitations to such data collection. The study has described a systematic method for developing clinical indicators for national audit. The indicators proved robust and reliable in primary and secondary care as well as long-term care settings.
Mian
Sarah
S
Clinical Effectiveness and Evaluation Unit, Royal College of Physicinas, London, UK.
Wagg
Adrian
A
Irwin
Penny
P
Lowe
Derek
D
Potter
Jonathan
J
Pearson
Michael
M
D003697:Delphi Technique; D003953:Diagnosis-Related Groups; D004739:England; D005242:Fecal Incontinence / Q000628:therapy*; D006801:Humans; D008485:Medical Audit; D011320:Primary Health Care; D011785:Quality Assurance, Health Care / Q000592:standards*; D013222:State Medicine; D014549:Urinary Incontinence / Q000628:therapy*