Sensitivity

The criterion sensitivity shows interactions with many other criteria of the category scientific soundness. With insufficient validity, risk adjustment or reliability, a high sensitivity cannot be expected. On the other hand, conditions for a high sensitivity are created by fulfilling other criteria. An optimization of sensitivity may possibly be achieved by accepting a lower specificity.

The meaning of this criterion depends on the intended application of the quality indicator: for the internal quality management, a high sensitivity can be of importance, in order to recognize as many problems as possible.

A bias can be introduced if the same individual serves as an evaluator in the Structured Dialogue? and as a developer of the quality indicators.

Sensitivity is only applicable in connection with a reference range, because by definition a reference range is required for a conspicuous outcome.

Definition
Sensitivity describes the probability that existing quality deficiencies for the area being assessed can be identified. A high quota of correctly identified quality deficiencies correlates with a high sensitivity.

Core Statement
The following statement is assessed: “The indicator is sufficiently sensitive.”

Information Base for the Assessment
As an information base for this criterion, a formalized and uniform Structured Dialogue can be taken into consideration. For the assessment of the sensitivity, a comparison with a gold standard is necessary. However, a gold standard for the measurement of quality and for the identification of quality deficiencies is not available nationally and internationally. The formalized and uniform Structured Dialogue can be used as a surrogate measure in conspicuous and inconspicuous institutions. For this process, it is necessary that not only conspicuous institutions (because of the quality indicator and its reference range) are evaluated, but that a representative sample of hospitals is achieved. The Structured Dialogue should for this purpose as far as possible be blinded in regard to the conspicuousness or inconspicuousness of the institution. The sensitivity is then estimated by the proportion of conspicuous providers (true positives) from all providers who identified quality problems with the care aspect under consideration.

The Information base should include the estimated prevalence of the quality deficiency and the predictive values.

Assessment Process
The assessment is based on an estimation of sensitivity. Experiences for the assessment of the sensitivity are currently not yet available for QUALIFY and are also not described in the literature.

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