Specificity

The meaning of this criterion depends on the setting: internal quality management can be done without a high specificity, because the cause of conspicuous results can be clarified in a more thorough analysis.

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

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

Definition
Specificity describes the probability that an inconspicuous quality is connected with an unremarkable indicator expression.

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

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 specificity, 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 could be used as a surrogate in conspicuous and inconspicuous hospitals. For this, it is necessary that not only conspicuous hospitals, 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 hospital.

Additionally to the specificity, the information base should include the estimated prevalence of the quality deficiency and the predictive values.

Assessment Process
The assessment is based on an expert estimation of the specificity. Experiences for the assessment of the specificity 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