Quality indicators for in-hospital pharmaceutical care of Dutch elderly patients: development and validation of an ACOVE-based quality indicator set

Drugs Aging. 2011 Apr 1;28(4):295-304. doi: 10.2165/11587700-000000000-00000.


Background: In 2001, the ACOVE (Assessing Care Of Vulnerable Elders) quality indicators (QIs) were developed in the US to measure the quality of care of vulnerable elderly patients. However, the ACOVE QI set was developed mainly to assess the overall quality of care of community-dwelling vulnerable elders (as opposed to hospitalized elderly). Therefore, they need to be adapted when used in a non-US hospital setting. In addition, the ACOVE QIs depend on patient and caretaker interviews to assess the quality of care.

Objective: The aim of this study was to develop and validate a set of explicitly phrased QIs to measure (without the need for interviews) the quality of pharmaceutical care of elderly hospitalized patients in the Netherlands.

Study design: The QI set was developed based on the ACOVE QIs, Dutch national guidelines, evidence from the literature and expert opinion. The QI set focused on in-hospital pharmaceutical care and was evaluated in terms of whether the QIs were able to assess the quality of care using medical records and a hospital information system. In three review rounds, the QI set was adapted and judged on face and content validity. The feasibility of implementation of the QI set and inter-rater reliability were determined.

Setting: The study was conducted between September 2007 and August 2008 in a tertiary 1002-bed university hospital. RESEARCH TEAM: Two pharmacists were responsible for the selection and adaptation of QIs. An internist-geriatrician, a physician with experience in quality assurance and internal medicine and a senior hospital pharmacist formed the expert panel responsible for reviewing the QIs.

Measurements: Fleiss' κ values and the intraclass correlation coefficient were calculated for inter-rater reliability.

Results: An 87-item QI set was accepted by the expert panel. Of this set, 49 QIs were based on ACOVE QIs and 38 QIs were newly added. The QI set demonstrated excellent inter-rater reliability and good feasibility.

Conclusions: We developed a valid and reliable set of QIs to efficiently assess the quality of the in-hospital pharmaceutical care provided to elderly Dutch patients.

MeSH terms

  • Aged
  • Geriatrics
  • Health Services for the Aged / standards
  • Hospitalization
  • Hospitals
  • Hospitals, University
  • Humans
  • Inpatients
  • Netherlands
  • Pharmaceutical Services / standards
  • Pharmacy
  • Process Assessment, Health Care
  • Quality Indicators, Health Care*
  • Quality of Health Care
  • Reproducibility of Results