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International Journal for Quality in Health Care Advance Access originally published online on March 13, 2008
International Journal for Quality in Health Care 2008 20(3):162-171; doi:10.1093/intqhc/mzn008
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© The Author 2008. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved

An international review of projects on hospital performance assessment

Oliver Groene1,2, Jutta K. H. Skau3 and Anne Frølich4

1 Research and Education, Avedis Donabedian Research Institute, Barcelona, Spain
2 CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
3 Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
4 Bispebjerg Hospital, Copenhagen, Denmark

Background. Assessing the quality of health care has become increasingly important in health care in response to growing demands from purchasers, providers, clinicians and the public. Given the increase in projects and programs to assess performance in health care in the last 15 years, the purpose of this paper is to review current indicator projects for hospital performance assessment and compare them to the Performance Assessment Tool for Quality Improvement in Hospitals (PATH), an initiative by the WHO Regional Office for Europe.

Methodology. We identified current indicator projects through a systematic literature search and through contact with experts. Using an inductive approach based on a review of the literature, we identified 10 criteria for the comparison of indicator projects. We extracted data and contacted the coordinators of each indicator project to validate this information. In addition, we carried out interviews with coordinators to gather additional information on the evaluation of the respective projects.

Results. We included 11 projects that appear to have adopted a common methodology for the design and selection of indicators; however, major differences exist with regard to the philosophy, scope and coverage of the projects. This relates in particular to criteria such as participation, disclosure of results and dimensions of hospital performance assessed.

Conclusion. Hospital performance assessment projects have become common worldwide, and initiatives such as the WHO PATH project need to be well coordinated with existing projects. Our review raised questions regarding the impact of hospital performance assessment that should be pursued in further research.

Keywords: quality improvement, quality management, quality indicators, measurement of quality

Address reprint requests to: Jutta K. H. Skau, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen K, Denmark. E-mail: jskau{at}stud.ku.dk

Accepted for publication February 2, 2008.


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