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International Journal for Quality in Health Care 15:523-530 (2003)
© 2003 International Society for Quality in Health Care


Methodology Matters

Defining and classifying clinical indicators for quality improvement

Jan Mainz

The National Indicator Project and University of Aarhus, Denmark

Objective. This paper provides a brief review of definitions, characteristics, and categories of clinical indicators for quality improvement in health care.

Analysis. Clinical indicators assess particular health structures, processes, and outcomes. They can be rate- or mean-based, providing a quantitative basis for quality improvement, or sentinel, identifying incidents of care that trigger further investigation. They can assess aspects of the structure, process, or outcome of health care. Furthermore, indicators can be generic measures that are relevant for most patients or disease-specific, expressing the quality of care for patients with specific diagnoses.

Conclusions. Monitoring health care quality is impossible without the use of clinical indicators. They create the basis for quality improvement and prioritization in the health care system. To ensure that reliable and valid clinical indicators are used, they must be designed, defined, and implemented with scientific rigour.

Keywords: clinical indicators, definitions, outcome measures, performance measures, quality improvement, quality of care

Accepted for publication August 7, 2003.


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