Suitability of three indicators measuring the quality of coordination within hospitals.
BACKGROUND
Coordination within hospitals is a major attribute of medical care and influences quality of care. This study tested the validity of 3 indicators covering two key aspects of coordination: the transfer of written information between professionals (medical record content, radiology exam order) and the holding of multidisciplinary team meetings during treatment planning.


METHODS
The study was supervised by the French health authorities (COMPAQH project). Data for the three indicators were collected in a panel of 30 to 60 volunteer hospitals by 6 Clinical Research Assistants. The metrological qualities of the indicators were assessed: (i) Feasibility was assessed using a grid of 19 potential problems, (ii) Inter-observer reliability was given by the kappa coefficient () and internal consistency by Cronbach's alpha test, (iii) Discriminatory power was given by an analysis of inter-hospital variability using the Gini coefficient as a measure of dispersion.


RESULTS
Overall, 19281 data items were collected and analyzed. All three indicators presented acceptable feasibility and reliability (, 0.59 to 0.97) and showed wide differences among hospitals (Gini, 0.08 to 0.11), indicating that they are suitable for making comparisons among hospitals.


CONCLUSIONS
This set of 3 indicators provides a proxy measurement of coordination. Further research on the indicators is needed to find out how they can generate a learning process. The medical record indicator has been included in the French national accreditation procedure for healthcare organisations. The two other indicators are currently being assessed for inclusion.
Minvielle
Etienne
E
Coordination for Measuring Performance Assuring Quality in Hospitals (COMPAQH), CERMES and Institut Gustave Roussy, INSERM (U988), 39, rue Camille Desmoulins 94805 Villejuif cedex, France. etienne.minvielle@igr.fr
Leleu
Henri
H
Capuano
Frédéric
F
Grenier
Catherine
C
Loirat
Philippe
P
Degos
Laurent
L
D003266:Continuity of Patient Care / Q000592:standards*; D005602:France; D006788:Hospitals, Voluntary / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D008499:Medical Records; D008505:Medical Staff, Hospital; D010348:Patient Care Team / Q000592:standards*; D019984:Quality Indicators, Health Care