About Performance Measures
Measuring health care structures, processes and outcomes is key to assessing the quality of care and supporting quality improvement in health care (1,2). In practice, different terms are used (e.g., performance measure, clinical indicator, quality indicator, performance indicator) and are sometimes used interchangeably or to mean different concepts. Guideline-based performance measures can be used to support quality improvement, using evidence for improved patient outcomes including patient-reported outcomes, based on systematic review of the evidence and robust guideline development processes and methods.
(1)The Joint Commission on Accreditation of Healthcare Organizations(JCAHO). Characteristics of clinical indicators. QRB Qual Rev Bull. 1989;15(11):330–9.
(2)K Edward and H. Jermy, Health care quality indicators project conceptual framework paper. 2006: OECD Health Working Papers: 23, https://www.oecd.org/els/health-systems/36262363.pdf.
Aims & Objectives
The GIN Performance Measures Working Group (PMWG) was set up 2012 to strengthen the link between evidence-based guideline recommendations and evaluation of quality improvement by performance measures. It has the following aims:
1. To improve reporting on development and aims of guideline-based performance measures
The first objective in 2012 was set to develop standards for guideline-based performance measure development. When discussed again in 2013/2014, the group decided on the development of reporting standards rather than development standards because of a lack of a broad common methodological basis.
2. To define requirements to enable guideline-based performance measurement
When discussing methodological standards with an international perspective, the differences in guideline group processes and context led to the aim to share our different experiences and to learn about our shared needs. The aim of this is to successfully develop guideline-based performance measures and to implement them effectively to improve health care.
3. To set methodological standards for high quality guideline-based performance measures
Although planned, the group still did not agree on methodological standards for guideline-based performance measures. However, this remains a goal and we continue to explore how this can be achieved.
1. The group published 2016 “Reporting standards for guideline-based performance measures.” (Nothacker M, Stokes T, Shaw B, Lindsay P, Sipilä R, Follmann M, Kopp I; Guidelines International Network (G-I-N) Performance Measures Working Group. Reporting standards for guideline-based performance measures. Implement Sci. 2016 Jan 15;11:6. doi: 10.1186/s13012-015-0369-z. PMID: 26772173; PMCID: PMC4714427.)
A comparative review on guideline-based performance measures in different countries found reporting still improvable – and showed very different measures in different countries (Becker M, Breuing J, Nothacker M, Deckert S, Brombach M, Schmitt J, Neugebauer E, Pieper D. Guideline-based quality indicators-a systematic comparison of German and international clinical practice guidelines. Implement Sci. 2019 Jul 9;14(1):71. doi: 10.1186/s13012-019-0918-y. Erratum in: Implement Sci. 2020 May 20;15(1):36. PMID: 31288828; PMCID: PMC6617919.)
2. Group members took part in a qualitative study on experiences with guideline-based performance measures. From this, practical suggestions on how to realise PM could be derived as one result were gathered. Project outline and results were shared and discussed at the 2017 and 2018 GIN conferences (Nothacker M, Bolster M, Steudtner M, Arnold K, Deckert S, Becker M, Kopp I, Schmitt J. International experiences in the development and implementation of guideline-based quality indicators: a qualitative study. BMJ Open. 2021 Jan 9;11(1):e039770. doi: 10.1136/bmjopen-2020-039770. PMID: 33468525; PMCID: PMC7817790.
3. Group members added to the update of a systematic review on approaches of integrating guideline-development and performance measures (Langendam MW, Piggott T, Nothacker M, Agarwal A, Armstrong D, Baldeh T, Braithwaite J, Castro Martins C, Darzi A, Etxeandia I, Florez I, Hoving J, Karam SG, Kötter T, Meerpohl JJ, Mustafa RA, Muti-Schünemann GEU, van der Wees PJ, Follmann M, Schünemann HJ. Approaches of integrating the development of guidelines and quality indicators: a systematic review. BMC Health Serv Res. 2020 Sep 16;20(1):875. doi: 10.1186/s12913-020-05665-w. PMID: 32938461; PMCID: PMC7493171.)
- Agreeing on methodological standards for the development of high-qualityguideline-based performance measures
- Agreeing on a pragmatic set of requirements for guideline-based performance measures as a guide for guideline groups to contribute to performance measures at different levels (from highlighting important recommendations for measurement to developing final recommendation-based measures)
Selected Publications on Guideline-Based Performance Measures
- Piggott T, Langendam M, Parmelli E, Adolfsson J, Akl EA, Armstrong D, Braithwaite J, Brignardello-Petersen R, Brozek J, Gore-Booth J, Follmann M, Leś Z, Meerpohl JJ, Neamţiu L, Nothacker M, Qaseem A, Giorgi Rossi P, Saz-Parkinson Z, van der Wees P, Schünemann HJ. Bringing two worlds closer together: a critical analysis of an integrated approach to guideline development and quality assurance schemes. BMC Health Serv Res. 2021 Feb 24;21(1):172. doi: 10.1186/s12913-020-05819-w. PMID: 33627104; PMCID: PMC7903641.
- Parmelli E, Langendam M, Piggott T, Adolfsson J, Akl EA, Armstrong D, Braithwaite J, Brignardello-Petersen R, Follmann M, Leś Z, Meerpohl JJ, Neamtiu L, Qaseem A, Rossi PG, Saz-Parkinson Z, van der Wees PJ, Schünemann HJ. Guideline-based quality assurance: a conceptual framework for the definition of key elements. BMC Health Serv Res. 2021 Feb 24;21(1):173. doi: 10.1186/s12913-021-06148-2. PMID: 33627092; PMCID: PMC7903784.
- Rückher J, Lobitz J, Follmann M, Derenz S, Schmidt S, Mensah J, Wesselmann S. Guideline-Based Quality Indicators for Kidney and Bladder Cancer in Germany: Development and Implementation. Urol Int. 2021 Aug 12:1-8. doi: 10.1159/000517893. Epub ahead of print. PMID: 34384078.
- Follmann M, Eigentler T, Adam H, Wenzel G, Langer T, Wesselmann S. Quality assurance in melanoma care: guideline-based quality indicators for melanoma – implementation, evaluation and update process. J Dtsch Dermatol Ges. 2020 Aug;18(8):848-857. doi: 10.1111/ddg.14149. Epub 2020 Jun 23. PMID: 32578392.
- Artis KA, Dweik RA, Patel B, Weiss CH, Wilson KC, Gagliardi AR, Huckson S, Nothacker M, Adhikari NKJ, Kajdacsy-Balla Amaral AC, Barbash IJ, Carlos WG, Costa DK, Metersky ML, Mularski RA, Sjoding MW, Thomson CC, Hyzy RC. Performance Measure Development, Use, and Measurement of Effectiveness Using the Guideline on Mechanical Ventilation in Acute Respiratory Distress Syndrome. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2019 Dec;16(12):1463-1472. doi: 10.1513/AnnalsATS.201909-665ST. PMID: 31774323; PMCID: PMC6956829.
- MacLean CH, Kerr EA, Qaseem A. Time Out – Charting a Path for Improving Performance Measurement. N Engl J Med. 2018 May 10;378(19):1757-1761. doi: 10.1056/NEJMp1802595. Epub 2018 Apr 18. PMID: 29668361.
Quality Indicator-Manual for oncological Guidelines
Selected further information on methodology of performance measures:
National Quality Forum USA – https://www.qualityforum.org/measuring_performance/measuring_performance.aspx
AAOS, USA – https://www.aaos.org/globalassets/quality-and-practice-resources/quality-performance-measures-resouces/pm_methods_v2.pdf
NICE, UK – https://www.nice.org.uk/standards-and-indicators
How to Join
GIN members who are interested in joining should write to: firstname.lastname@example.org
Chair – Beth Shaw
Board Liaison – Zac Munn