Improving the quality of health care: Research methods used in developing and applying quality indicators in primary care

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Abstract
What are quality indicators? Indicators are explicitly defined and measurable items referring to the structures, processes, or outcomes of care.3 Indicators are operationalised by using review criteria and standards, but they are not the same thing; indicators are also different from guidelines (box 1). Care rarely meets absolute standards,5 and standards have to be set according to local context and patient circumstances. 6 7 Activity indicators measure how frequently an event happens, such as the rate of influenza immunisation. In contrast, quality indicators infer a judgment about the quality of care provided,6 and performance indicators8 are statistical devices for monitoring performance (such as use of resources) without any necessary inference about quality. Indicators do not provide definitive answers but indicate potential problems or good quality of care. Most indicators have been developed for use in hospitals but they are increasingly being developed for use in primary care.