Methods: The conceptual framework for GBPM development was established based on a systematic review of 48 articles and an environmental scan of processes for performance measures development by leading national and international organizations. The resulting framework is comprised of six steps: guideline selection, extraction of recommendations, indicator selection and development, practice test and validation, implementation, and data quality assessment and evaluation.
In the first step of the framework, which begins with guideline selection, GBPM are developed for guidelines that are focused on health system priorities (Grdisa et al., 2018). A preliminary scan of external data repositories is conducted to identify existing performance measures for the guideline topic. The results of this review are disseminated for stakeholder feedback, ensuring reduced reporting burden and filling in gaps for measurement. Through this process, the research questions are refined, further informing the development of GBPM. The second step is the extraction of recommendations to identify potential measures for development. Thirdly, GBPM are selected and developed by aligning with external data repositories and health information data libraries. Several criteria are considered, such as the strength of supporting evidence, feasibility to measure and monitor, and the potential to impact on patient/client outcomes. In this process, integration of guideline development and implementation, technology (order sets) and evaluation are considered. In the fourth step, GBPM are internally validated through face and content validity, as well as externally validated based on the criteria of relevance, feasibility, readability and usability. National and international organizations participate in the external validation process to better understand the implications of GBPM in a global context. A wide range of external perspectives are incorporated, including an expert panel, external stakeholders, policy members and organizations involved in quality improvement. The fifth step of the conceptual framework is implementation, where GBPM and the guideline are published concurrently. Organizations begin their data collection process to evaluate evidence-based practice, and provide ongoing feedback regarding validity, feasibility of data collection, and recommendations for any future refinements. Lastly, step six of the framework focuses on conducting the data quality assessment and evaluation to create a continuous cycle.
Results: Based on the data collected from 2012 to 2017, the GBPM were categorized as high, moderate and low-utilization. During the GBPM refinement process, the high and moderately utilized GBPM were further analyzed based on alignment with external data repositories. The under-utilized GBPM were monitored based on feasibility and relevance. Based on the analyses, GBPM were refined or retired periodically. In addition, according to the five year guideline life cycle, the GBPM were revised or retired by monitoring utilization.
Conclusion: The development of GBPM within a conceptual framework supports evaluation of evidence-based practice and enhances data quality.