Introduction

The purpose of this chapter is to review the state of the art in developing clinical process measures and to describe some of the schemes that are using these measures for health system improvement. A high-level summary of the major steps involved in constructing good clinical process measures is provided to enable policy-makers to appreciate some of the complexities involved. There is not enough detail for novices to be able to develop measures from this source alone, but interested readers will be pointed towards examples of best practice.

The section on current schemes that employ clinical process measures includes a greater number of examples from the United States. This reflects the fact that clinical process measurement has been undertaken systematically in the United States for a longer period. Much activity is currently underway in several countries but the measures being used are not readily accessible. Some of these schemes may therefore be under-represented in this chapter.

The chapter concludes with some thoughts on the best uses of process measures, particularly in comparison to outcomes measures. In general, both play an important role in stimulating quality improvement at different levels in the health system and neither type of measure alone is sufficient for all applications. Some directions for future research in this area are also proposed.

State-of-the-art development of clinical process measures

Developers generally pass through five steps to create state-of-the-art measures: (i) selecting topics; (ii) reviewing clinical evidence; (iii) identifying clinical process indicators; (iv) constructing process measures; and (v) creating scoring methods. The importance of each step is discussed below, together with what constitutes best practice.