Barriers to Implementation Considered

This criterion captures possible barriers which can endanger an adequate use of the indicator. Such barriers could, for example, include additional costs to the health care system with care delivery that considers the quality indicator or contradictory recommendations between competing guidelines.

It has to be considered that a lack of understandability of the indicator or an inadequate collection effort can also represent implementation barriers. These factors are evaluated as independent criteria.

The assessment of this criterion provides information on ongoing processes, as to whether further development of a procedure with reduced or eliminated barriers of implementation is possible (prospective assessment). For the assessment of the suitability of a currently used indicator for public reporting (retrospective assessment), this criterion is not relevant.

However, existing barriers of implementation do not automatically mean a methodological weakness of the quality indicator. In contrary, for example additional costs with indicator-appropriate care can be an explicit justification for the relevance of an indicator (see “importance of the quality characteristic captured by the quality indicator for the patients and the health care system”). In this context, it is also important to know whether the assessment of care through quality indicators is done voluntarily or whether participation is mandatory.

Experiences in the application of this criterion are lacking. This criterion is common practice in the development of guidelines, where barriers for a successful implementation have to be overcome. This criterion is not mentioned in commonly used sources of information for quality indicators. Future experiences will show whether this criterion withstands the test or whether it can possibly be used more effectively at the level of assessment of indicator sets.

Definition
With the development / further development of the indicator possible barriers in the implementation have been analyzed and if necessary given consideration.

Core Statement
The following statement is assessed: “No known implementation barriers or they are given consideration through appropriate measures.”

Information Base for the Assessment
For the assessment of the core statement, one searches on the basis of empirical experiences for indicator-specific barriers, which could prevent a successful implementation of a quality indicator.

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