An evidence-based evaluation of quality and efficiency indicators.

The goal of this study was to identify and appraise quality and efficiency indicators relevant to hospitals or physicians' practices by performing a systematic literature search. Process indicators were limited to 11 diagnoses and treatments. To appraise the indicators identified, a framework for grading health care recommendations was expanded to categorize evidence on cost-effectiveness. Seven indicators of structural quality and 34 indicators of process quality were identified and appraised. The set of performance indicators could serve as a state-of-the-art system of measurement for governments and organizations evaluating the quality and efficiency of health care.