Balancing science and practice in indicator development: the Maryland Hospital Association Quality Indicator (QI) project.

This paper describes the technical and conceptual aspects in the development of an indicator project to measure hospital performance. Almost a decade ago, a research based--hence explorative, series of inpatient and ambulatory care indicators were developed. This paper describes some of the most fundamental technical and applied knowledge gleaned from the study and applicable to all quality assurance/quality improvement activities. These findings, and the resulting indicator development guiding principles, are based on more than 900 hospitals' experience in the US, Japan, and England. Although this paper presents the necessary scientific underpinning for a valid and reliable analysis, its principal emphasis is on the practical applicability of this decade old research project aimed at measuring select outputs of performance and identifying and explaining the determinants of these outputs.