Researchers: Ahuva Weiss-Meilik¹, Yaniv Sherer²

Background: In 2013, a national health indicators program (NHIP) was initiated, reporting in-patients clinical quality measures. Measurement processes may lead to improvements in additional aspects of the medical care. However, it may create a "tunnel effect", when directing it efforts to improve specific measures, at the expense of other aspects of medical care. With the initiation of NHIP, it is of major importance to assess the expected impact on hospitals' quality of care.

Objectives: To examine the impact of NHIP on additional process indicators and on clinical outcomes, relevant to the reported quality indicators.

Method: The study will compare three periods: pre-intervention, initiation of the program, and long-term effect evaluation. Data extracted both from the organizational database and manually collected. Comparison of process and outcome measures across study periods will be carried-out using appropriate statistical tests, adjusted for case-mix variability.

Findings: Implementing the program led to an increase in all five quality measures. Thou, this was not the case for most of the examined process measures and clinical outcome. In the surgical wing, we found an improvement in the incidence of death. This can most likely be related to the organizational climate change or patient's case mix variability.

Conclusions: The national health indicators program had limited impact regarding clinical outcomes and complications. The main effect of the program was to create a national dialogue that encourages a climate of measurement, learning and performance improvement related to quality of care.

Recommendations: This study will provide insight to decision makers about the impact of the NHIP, thus allowing steering the following steps of the program, in an evidence-based manner.

Research end date: 08/2017