title: Quality improvement in New Zealand healthcare. Part 4: achieving effective care through clinical indicators.
abstract: Clinical indicators can be a powerful means of improving the effectiveness of patient care. In this fourth article in the Series on quality improvement we identify the key attributes of clinical indicators and provide a scheme for their critical appraisal. Clinical indicators are objective measures of the process or outcome of patient care. They can be used to monitor care; to flag potential opportunities to improve care, and to provide evidence that a change in practice has resulted in improvement. Clinical involvement from the "bottom up" helps to ensure that indicators are used in a formative way with a focus on "quality improvement," rather than as a summative mechanism for "top-down" external accountability which attempts to "assure" quality. In some cases, such external quality assurance can actually harm quality improvement efforts.
authors.forename: John
authors.initials: J
authors.lastname: Buchanan
authors.forename: Allan
authors.initials: A
authors.lastname: Pelkowitz
authors.forename: Mary
authors.initials: M
authors.lastname: Seddon
mesh_terms: D003362:Cost-Benefit Analysis; D018166:Health Care Reform / Q000379:methods; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration / Q000592:standards; D009520:New Zealand; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results