Dr.sherin elsherbiny Clinical pathology Senior registrar M.D Clinical microbiology Infection control specialist IC . RRT Member (Riyadh Region) & Clinical auditor

1. Dr.sherin elsherbiny
Clinical pathology Senior registrar
M.D Clinical microbiology
Infection control specialist
IC . RRT Member (Riyadh Region) & Clinical auditor

2. Lecture contents
• Introduction
• Indicator definition
• Categories
• Criterion
• Conclusion
• References

3. Health indicators
• How we do?
• Are we doing well--------where we want to be ??

4. What Are Indicators
• Indicators are TOOLS that enables professionals and
organizations to MONITOR and evaluate what
happens to patients as a consequence of HOW WELL
professionals and organizational SYSTEMS FUNCTION
to provide the needs of patients

5. Categories of Health indicators
BUT can be divided into different dimensions according to the
aspects of care being assessed
PROCESS
OUTCOME
STRUCTURE

6. STRUCTURE
• Structural indicators describe the type and amount of
resources used by a health system or organization to deliver
programs and services, and they relate to the presence or
number of staff, clients, beds, supplies, and buildings.
e.g Proportion of specialists to other doctors

7. PROCESS
• Process indicators assess,
What the provider did for the patient and how well it was done.
e.g ,
• Proportion of patients assessed by a doctor within 24 hours of referral
• Long stay in ER

8. OUTCOME
• Outcomes are events that follow patient care, and that is
affected by health care.
An ideal outcome indicator would capture the effect of care
processes on the health and wellbeing of patients and
populations.

9. Bad Outcomes can be expressed as ‘The 5 Ds’ :
1. Dissatisfaction: emotional reactions to disease and its care,
such as sadness and anger.
2. Discomfort: symptoms such as pain, nausea, or dyspnea
3. Disability: impaired ability connected to usual activities at
home, or work
4. Disease: symptoms, physical signs, and laboratory
abnormalities
5. Death: a bad outcome

10. Other Categories of Health
indicators
• Generic or disease-specific
• Type of care ( Preventive ,Acute , Chronic )
• Function ( Screening, Diagnosis, Treatment, Follow up)
• Modality
1. Physical examination
2. Laboratory/radiology study
3. Medication
4. Other interventions
5. History
• Rate-based or sentinel

11. Generic indicators and disease-specific indicators
Generic indicators measure aspects of care that are
relevant to most patients.
• Proportion of specialists to other doctors registered
• patients in the emergency department > 6 hours
• Unscheduled returns to the operating room
• In-patient mortality
While disease-specific indicators are diagnosis-specific and
measure particular aspects of care related to certain diseases e.g
Proportion of patients with diabetes mellitus who receive a retinal
exam. annually

12. Rate-based or sentinel indicators
• A rate-based indicator uses data about events that are
expected to occur with some frequency.
These can be expressed as proportions or rates (within a given
time period), ratios, or mean values for a sample population.
To permit comparisons among providers or trends over time,.
e.g Hospital-acquired bacteremia

13. sentinel indicator
• Sentinel events represent the extreme of poor performance
They are generally used for risk management.
e.g Numbers of patients who die during surgery

14. Criteria of indicator I
• Evidence-based
• Based on agreed definitions
• Specific and sensitive, i.e It detects few false positives and
False negatives;
• Valid and reliable

15. Validity & Reliability
• Validity is the degree to which the indicator
measures what it is intended to measure,
• Reliability is the extent to which repeated
measurements of a stable phenomenon by different
data collectors, judges, or instruments, at different
times and places, get similar results.

16. Criteria of indicator II
• Indicator relates to clearly identifiable events, it is
relevant to clinical practice
• Discriminate well
• Permits useful comparisons
• Accountability

17. Conclusion
• Health indicators are tools to measure to which
extent the targets are achieved.
• They are expressed as numbers, rates, or
averages that can provide a basis for clinicians,
organizations, and planners aiming to achieve
improvement in care
• They can be measures of structure, process, and
outcome, either as generic measures relevant for
all patients, or disease-specific measures

18. References
• Defining and classifying clinical indicators for quality improvement _ International
Journal for Quality in Health Care ,,Volume 15, Issue 6Pp. 523 – 530, 2016
• Performance measurement for health system improvement, experiences,
challenges and prospects, Peter C. Smith, Elias Mossialos and Irene Papanicolas,
World Health Organization 2008 Organization, on behalf of the European
Observatory on Health Systems and Policies 2008
• Health Indicators, Cheryl Wold, MPH and Associates, (AHRQ). July 2008