Criteria and Standard

1. Criteria and Standard

2. Objectives • To define performance indicator, criteria and standard

3. Criterion (definition) • A systematically developed statement that can be used to assess the appropriateness of specific healthcare decisions, services, and outcomes (Institute of Medicine, 1992)

4. Definitions of a ‘standard’ • An objective with guidance for its achievement given in the form of criteria sets which specify required resources, activities, and predicted outcomes (Royal College of Nursing, 1990) • The level of care to be achieved for any particular criterion (Irvine and Irvine, 1991) • The percentage of events that should comply with the criterion (Baker and Fraser, 1995)

5. Definition of an indicator

6. Criteria • structure (what you need) • process (what you do) • outcome of care (what you expect).

7. Structure criteria • Structure criteria refer to the resources required • the numbers of staff and skill mix • organisational arrangements, • the provision of equipment and • physical space

8. Process criteria • Process criteria refer to the actions and decisions taken • communication, • assessment, • education, • investigations, • prescribing, • surgical and other therapeutic interventions, • evaluation, and • documentation.

9. Process criteria • Process criteria are more sensitive measures of the quality of care, as a poor outcome does not occur every time there is an error or omission in the provision of care. • the importance of process criteria is determined by the extent to which they influence outcome

10. Outcome criteria • Outcome criteria are typically measures of the physical or behavioural response to an intervention and reported health status

11. Outcome criteria • Some audits focus specifically on outcomes and collect data about the outcomes of care. This is a practical possibility when outcomes are easily measurable and occur soon after the delivery of care. • If the outcomes are also of major importance to users, for example postoperative complications, the direct measurement of outcome is not only appropriate but also expected

12. Outcome criteria • When outcomes are used for comparative audit, adjustments may be needed for case mix, a process known as ‘risk adjustment’.

13. Developing valid criteria/ standard • Based on evidence • Related to important aspects of care • Measurable

14. methods of developing criteria

15. Using guidelines • Recommendations from clinical practice guidelines can be used to develop criteria and standards without substantial additional work

16. Prioritising the evidence method • This method of developing criteria reviews the evidence in the source guidelines or systematic reviews for each element of care identified as important in determining outcome • The criteria that have most impact on outcome are then categorised as ‘must do’ or ‘should do’

17. RAND/UCLA appropriateness method • The findings of a literature review are submitted to a panel of clinicians, chosen for their clinical expertise and professional influence, who are asked to rate the appropriateness of a set of possible indications for the particular procedure

18. Examples of criteria • New benzodiazepine prescriptions must only be issued for short-term relief (no longer than four weeks) of severe anxiety or insomnia

19. Methods for developing standards

20. Using levels of performance achieved in trials • the levels of performance achieved in trials are helpful, but should not be regarded as uniformly achievable in unselected patient populations.

21. Benchmarking • An organisation first identifies the areas of practice where the quality of patient care would benefit from comparison and sharing of information about the processes involved in achieving high performance • Then it compares its performance with that of its most successful ‘competitors’ and considers areas for development in the light of the comparison

22. Care pathways • Integrated care pathways define the expected timing and course of events in the care of a patient with a particular condition • They describe explicitly all the expected processes of care. • Care pathways are easier to introduce when there is established routine practice and little variation between users

23. Example for blood transfusion • Donors should have a health check prior to donation(criterion). • We would expect 100% compliance, it is mandatory for all donors(standard).