Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
J Manag Care Spec Pharm. 2015 Feb;21(2):144-52. doi: 10.18553/jmcp.2015.21.2.144.
In 2008, the Dutch Health Care Transparency Programme (Zichtbare Zorg) was set up to develop and apply quality indicators (QIs) for health care. These QIs serve a range of purposes and can be categorized into those for internal use--for meeting quality standards and to continuously measure improvement (formative)--and external use--to enable patients and health insurance companies to distinguish between health care providers (summative). In order to assess the validity of QIs, a comprehensive Indicator Assessment Framework (IAF) was developed. This framework specifies the following criteria for validation: content validity, absence of selection bias, absence of measurement bias, and statistical reliability. Because of the intended summative use, the IAF was used for structural assessment of the QIs set for Dutch community pharmacists.
To assess the validity of the current set of 52 QIs for community pharmacies using the IAF.
An expert panel applied the IAF criteria to the set of QIs collected in 1,807 Dutch community pharmacies on their performance in 2011. The QIs were judged as meeting, partly meeting, or not meeting the requirements regarding these criteria. The judgments were evaluated for QI type (structure, process, or outcome) and for predefined domains.
Thirteen QIs (25%) were judged as meeting the requirements for all criteria. Among them were 12 structure indicators and 1 process indicator. For process indicators, the criterion for measurement bias poorly met the requirements, and content validity was unsatisfactory for outcome indicators. The 13 overall valid QIs covered 6 out of 10 predefined domains: continuity of care, clinical risk management, compounding, dispensing of medication, management, and quality management.
When subjecting the QI set for community pharmacies to the requirements of the IAF, only a quarter of the QIs met all requirements. To increase the number of valid process and outcome indicators, meaningful aspects for the outcome of pharmaceutical care have to be defined, and uniform measurement of relevant processes has to be implemented.
2008 年，荷兰设立了医疗透明度计划（Zichtbare Zorg），旨在开发和应用医疗质量指标（QIs）。这些指标有多种用途，可以分为内部使用的指标，用于满足质量标准和持续衡量改进（形成性），以及外部使用的指标，使患者和健康保险公司能够区分医疗服务提供者（总结性）。为了评估 QIs 的有效性，开发了一个全面的指标评估框架（IAF）。该框架规定了以下验证标准：内容有效性、不存在选择偏差、不存在测量偏差和统计可靠性。由于预期的总结性使用，IAF 被用于对荷兰社区药剂师的 QIs 进行结构评估。
使用 IAF 评估当前 52 项社区药店 QIs 的有效性。
一个专家小组应用 IAF 标准评估了在 2011 年从 1807 家荷兰社区药店收集的一套 QIs，以评估其表现。这些 QIs 根据这些标准被判断为符合、部分符合或不符合要求。根据 QI 类型（结构、过程或结果）和预定义的域对判断进行评估。
13 项 QIs（25%）被判断为符合所有标准的要求。其中包括 12 项结构指标和 1 项过程指标。对于过程指标，测量偏差标准不符合要求，结果指标的内容有效性不令人满意。13 项整体有效的 QIs 涵盖了 10 个预定义域中的 6 个：连续护理、临床风险管理、制剂、药物配给、管理和质量管理。
当将社区药店的 QI 集置于 IAF 的要求下时，只有四分之一的 QIs 符合所有要求。为了增加有效的过程和结果指标的数量，必须为药学护理的结果定义有意义的方面，并实施相关过程的统一测量。
