Measuring quality of care: considering measurement frameworks and needs assessment to guide quality indicator development

J Clin Epidemiol. 2013 Dec;66(12):1320-7. doi: 10.1016/j.jclinepi.2013.05.018. Epub 2013 Sep 7.


Objective: In this article, we describe one approach for evaluating the value of developing quality indicators (QIs).

Study design and setting: We focus on describing how to develop a conceptual measurement framework and how to evaluate the need to develop QIs. A recent process to develop QIs for injury care is used for illustration.

Results: Key steps to perform before developing QIs include creating a conceptual measurement framework, determining stakeholder perspectives, and performing a QI needs assessment. QI development is likely to be most beneficial for medical problems for which quality measures have not been previously developed or are inadequate and that have a large burden of illness to justify quality measurement and improvement efforts, are characterized by variable or substandard care such that opportunities for improvement exist, and have evidence that improving quality of care will improve patient health.

Conclusion: By developing a conceptual measurement framework and performing a QI needs assessment, developers and users of QIs can target their efforts.

Keywords: Health care; Models; Needs assessment; Quality indicators; Quality of health care; Survey; Systematic review; Theoretical.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Humans
  • Needs Assessment*
  • Quality Indicators, Health Care / organization & administration*
  • Quality of Health Care / standards