Formalising Medical Quality Indicators to Improve Guidelines

Medical guidelines can significantly improve quality of medical care and reduce costs. But how do we get sound and well-structured guidelines? This paper investigates the use of quality indicators, which are formulated by medical institutions to evaluate medical care, to evaluate the guidelines. The main research questions are (i) whether it is possible to formalise those indicators in a specific knowledge representation language for medical guidelines, and (ii) whether it is possible to verify whether such guidelines do indeed satisfy these indicators. The research to answer these questions consists of a number of steps: 1. Choice of representation language. We have chosen Asbru as modelling language. It is a modelling language constructed specifically for guidelines. 2. Choice of guidelines. We have used two medical guidelines that were already formalised by a previous Protocure project. These guidelines concerned Diabetes and Jaundice. 3. Choice of indicators. For Jaundice the MAJIC indicators are used and for Diabetes the CBO quality indicators. A strong point of our case study is that these indicators are developed independently from the respective guidelines, by different organizations. 4. Translating indicators as goals. Indicators usually are measurements of the number of people for which the care has been performed as it should have been. In order to regard indicators as goals or intentions of a care-performance, we need to rephrase the indicators. 5. Modelling the indicators. For the actual modelling of the indicators in Asbru a step-wise translation is used. 6. Verifying the indicators. After the modelling, the formalised indicators can be used for verification. The verification has to be done manually, because no automated techniques are available yet. In the next sections, the results of step 5 and 6 are summarised as answers to above mentioned research questions i) and ii).