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Validation Criterions for Process Indicators

Article HAS - Mis en ligne le 27 oct. 2015

Clinical relevance

Clinical relevance evaluates the clinical importance of an indicator’s topic and its ability to improve the quality and safety of care or clinical situation related to the topic. This step is based on the analysis of existing professional and organisational references, legal texts and working group opinions. The working group is representative of all actors involved in the process subject to assessment: healthcare professionals, clinicians and medical information coders, patients and users of the healthcare system.


This is defined as the ability of the healthcare organisation to collect the data required to produce the indicator autonomously, and to assess the acceptability regarding the workload. In particular, it assesses the ability to access data source and the time spent collecting data.

Ability to result in healthcare quality improvement

  • Variability between healthcare organisations:  an indicator’s ability to distinguish healthcare organisations through observation of result variability.
  • Deviation from a benchmark: an indicator’s ability to identify areas of improvement through observation of a deviation from an expected benchmark.
  • Identification of corrective actions: a healthcare organisation's ability to identify achievable improvement actions.
  • Negative induced effects relate to an indicator's potential to create an undesirable behavior that will modify the indicator’s result without it actually being linked to the quality care (e.g., clinical practice documented as done when not actually performed).

Metrologic qualities

  • Reproducibility measures an indicator’s ability to produce similar results when repeated on a same patient record by another individual. It is assessed by inter-observer stability.
  • Internal consistency measures the internal consistency or homogeneity between items used to calculate a score.
  • Validity of face-to-face assesses if there is a mutual understanding of an indicator by all users.
  • Content validity measures an indicator's ability to represent all important dimensions of an assessed clinical situation.



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