gms | German Medical Science

Background: Active tool for implementation, such as indicators, are needed to ensure the use of guidelines in daily clinical practice.

Objectives: To describe the methods and results of studies aimed at identifying quality indicators based on clinical guidelines, and to assess the quality of these studies.

Methods: A systematic review. Publications (from 1995 to September 2009) were identified from the Medline and Cochrane databases. The search terms were health care quality indicators or indicators or process indicators and guideline or clinical guidelines or practice guidelines. Inclusion criteria were as follows: indicators guideline-based, explicitly described development process, the indicators were described, and the indicators targeted at multiple organisational levels.

Results: We identified 109 potentially eligible full-text articles. After assessments, 15 articles were included. The Modified Delphi method was used for evaluating and choosing potential indicators in 10 studies out of fifteen. In one study, the guideline developers themselves developed the indicators. The most commonly rated characteristics of potential indicators were relevance (n=10), validity (n=7) and feasibility (n=6). Indicators were seldom tested (6/15). The total number of potential and accepted indicators was 1,047 and 394, respectively. Of the accepted indicators, 347 (88%) measured the process. A clarifying flowchart on the development process was presented in five reports.

Conclusions: Since indicators should be evidence-based and dependent on local circumstances, it would be practical to develop indicators during the clinical guideline process.

Implications for guideline developers: We give recommendations for the development of guideline-based indicators and for the reporting of such studies.