Indicator Expression can be Influenced by Providers

This criterion is an important prerequisite for quality improvements through the use of quality indicators and it is also considered to be a central criterion in the literature. If the aspect under assessment is not changeable in the practical health care environment, then it cannot be beneficial for quality improvement procedures. That said, the criteria benefit and indicator expression can be influenced by providers”are closely connected.

The criterion Indicator expression can be influenced by providers differs in principle from the indicator evidence for outcome indicators. Regarding the indicator evidence for outcome indicators, scientific evidence is provided so that the measured outcome can basically be influenced by the providers (interrelation between outcome and process/structure). The criterion, Indicator expression can be influenced by providers evaluates, whether the evaluated provider can actually influence the health care outcome through control of processes within the given health care structures.

Examples for positive and negative ability to influence:

• A quality indicator “number of preventive examinations during pregnancy” is difficult to influence by the birth attendant, because these examinations fall under the responsibility of other physicians in German health care.
• However an indicator “indication of a safety margin in breast surgery by the pathologist” can definitely be influenced by the surgeon, because the pathologist is in a contractual relationship with the surgeon and the indication of a safety margin is an indispensable information for appropriate surgical performance.

Definition
Quality indicators must refer to aspects of care, in which the expression of the indicator can actually be influenced by the players being evaluated.

Core Statement
The following core statement is assessed: “The quality indicator refers to an aspect of care, which can be influenced by the players being evaluated.”

Information Base for the Assessment
The assessment of the core statement takes place on the basis of empirical experiences of the evaluating experts. In individual cases additional investigations may be necessary (e.g. regarding the actual availability of certain treatment methods in a certain setting).

Assessment Process
After all evaluators have acknowledged and understood the information base, they assess the core statement.

A detailed process description can be found in Appendix 1.

Assessment Stages
1 = does not apply
2 = rather does not apply
3 = rather applies
4 = applies
Abstention