Table 1 Characteristics of identified indicator sets (Country of origin)

Resident-centred quality indicators in residential aged care or The Campbell Report (Campbell Research and Consulting (CR&C) (Campbell Research and Consulting (CR&C) 2006))

Aged care

24 indicators. ‘Prevalence of medication use’ is the only medication-related indicator.

Not piloted and not operational (National Aged Care (National Aged Care Alliance 2014))

(Australia)

Public Sector Residential Aged Care Quality of Care Performance Indicators (Nay et al. 2004)

Aged care

6 indicators. Polypharmacy (9 or more medications) is the only medication-related indicator.

The set has been introduced across the whole of public service residential aged care in Victoria. No external reporting (National Aged Care (National Aged Care Alliance 2014)).

(Australia)

ResCareQA (Residential Care Quality Assessment formally the Clinical Care Indicators Tool or CCI) (Courtney et al. 2007; Courtney et al. 2011)

Aged care

23 indicators of which two are medication related. Polypharmacy (9 or more medications) and medication review.

Piloted (National Aged Care (National Aged Care Alliance 2014)) and assessed for content validity (Courtney et al. 2011).

(Australia)

National indicators of safety and quality in health care (Australian Institute of Health and Welfare 2009)

All health care sectors

55 indicators of which 5 relate to aged care and 1 to medication (annual medication review). 22 indicators with potential to evaluate medication-related quality of care in aged care such as pharmacological management of hypertension.

Not operational. Information relating to some of the indicators is available in various government reports.

(Australia)

Minimum Data Set (version 3.0) Nursing Home Quality Measures.(Centres for Medicare and Medicaid Services & USA: www.cms.gov Accessed [February 2014; Zimmerman et al. 1995; Hawes et al. 1997)

Aged care

18 measures covering several aspects of aged care (derived from Resident Assessment Instrument-MDS developed in 1995).Medication-related indicators include vaccination rates and use of antipsychotic medications.

Mandated quarterly reporting of indicators on Centres for Medicare and Medicaid website. Updated regularly.

(USA)

Assessing Care of Vulnerable Elders (version 3) or ACOVE–3 (Wegner et al. 2007)

Aged care and ambulatory elderly

392 indicators covering 26 conditions. Medication use addressed by 98 indicators including mediation specific indicators, medication review rates, continuity of care and medication list reconciliation.

Extensively reported in the scientific literature and used as a model for adaptations in other countries. Studies and reports available online.

(USA)

Healthcare effectiveness data and information set or HEDIS (National Committee for Quality Assurance & USA: www.ncqa.org Accessed [September 2013)

All health care sectors

83 indicators of which approximately one third are medication-related indicators including condition specific (e.g. treatment of COPD, asthma and diabetes) and general indicators (e.g. medication review, post-discharge medication reconciliation and medications to avoid in the elderly (Beer’s criteria)).

Approximately 90% of US health plans report this data voluntarily. Selected reports available online. Updated annually.

(USA)

Quality and Outcomes Framework or QOF (Primary Care & Social Care Information Centre 2013)

General practice

Over 140 indicators. Clinical indicators cover 22 clinical areas and contain many medication related indicators (e.g. appropriate treatment of hypertension and medication review).

Voluntary annual reporting by General Practice with pay-for-performance incentives. Results available online. Updated annually.

(UK)

Guiding principles for medication management in residential aged care facilities (Australia) (Department of Health 2012)

Aged care

17 guiding principles covering governance, prescribing, medication administration, medication storage and evaluating practice.

Released 2012. Not operational.

Indicators for Quality Use of Medicines in Australian Hospitals (NSW Therapeutic Assessment Group 2007) (Australia)

Hospital

30 indicators covering prescribing, medication monitoring and medicine education.

Not operational.

Indicators for Quality Prescribing in Australian General Practice (National Prescribing Service 2006) (Australia)

General practice

21 indicators covering prescribing, monitoring, education and review of medications.

Not operational.

Preventable Drug Related Morbidity (PDRM) (Mackinnon & Hepler 2002; Robertson & MacKinnon 2002; Morris et al. 2002) (Canada and USA)

Geriatric

52 indicators identifying health care utilisation due to inappropriate or failure to use medications. Each indicator explicitly states a pattern of care and the resulting outcome.

Reported in scientific literature.

Australian Prescribing Indicators Tool (Basger et al. 2008) (Australia)

General Practice

48 prescribing indicators for patients 65 years or older. Focus is on drug-drug and drug-disease interactions.

Reported in scientific literature.

Drug Burden Index or DBI (Hilmer et al. 2007)

General Practice

A patented formula for calculating the total sedative and anticholinergic load in an individual.

Reported in scientific literature.

(USA)

The PRISCUS List (Holt et al. 2010)

Geriatric Prescribing

83 potentially inappropriate medications in the elderly (> = 65 years) with recommendations and alternatives.

Reported in scientific literature.

(Germany)

Inappropriate Prescribing in the Elderly Tool or IPET (McLeod et al. 1997; Naugler et al. 2000)

Hospital

Originally the McLeod criteria, adapted in 2000 to the IPET which has 14 inappropriate prescribing indicators.

Reported in scientific literature.

(Canada)

Beer’s criteria (The American Geriatrics Society 2012)

Aged care and ambulatory care

Original set of indicators from 1991, last updated 2012. 53 recommendations for medications to be avoided in the elderly (> = 65) or avoided in elderly with certain conditions/medications.

Reported extensively in the scientific literature and used in the HEDIS dataset (Marcum & Hanlon 2012).

(USA)

Medication Appropriateness Index or MAI (Hanlon et al. 1992)

General Practice

Classifies appropriateness of each medication against ten criteria.

Reported in scientific literature.

(USA)

NORGEP criteria for assessing inappropriate prescriptions to elderly patients (Rognstad et al. 2009)

General Practice

36 criteria assessing use of particular medications and drug combinations in the 70+ population.

Reported in scientific literature.

(Norway)

Criteria for drug selection in frail elderly patients (Huisman-Baron et al. 2011)

Frail elderly

23 criteria to assess individual drug classes in the frail elderly.

Reported in scientific literature.

(Netherlands)

The Screening tool of Older Person’s Prescriptions (STOPP) and Screening Tool to Alert to Right Treatment (START) Criteria

Hospital and general practice

22 START (address under prescribing) and 65 STOPP (address inappropriate prescribing) criteria.

Extensively reported in the literature and currently used in an international database trial (The SENATOR Project & Europe: www.senator-project.eu Accessed [February 2014).

(O'Mahony et al. 2010; Barry et al. 2007; Gallagher & O'Mahony 2008)

(Ireland)

Criteria for high-risk medication use (Winit-Watjana et al. 2008)

Elderly

77 indicators to assess prescribing quality in the elderly.

Not operational

(Thailand)

Potentially inappropriate medications in elderly: a French consensus panel (Laroche et al. 2007)

> = 75 years

36 indicators covering medications to avoid and medications to avoid in certain conditions in the elderly.

Reported in scientific literature

(France)

Potentially inappropriate prescriptions for older patients in long-term care or PIP (Rancourt et al. 2004)

Aged care

111 prescribing indicators covering inappropriate medication, duration, dosage and medication combinations.

Reported in scientific literature

(Canada)

CRIteria to assess appropriate Medication use among Elderly complex patients (CRIME) (Onder et al. 2013)

Clinically complex elderly

19 recommendations addressing treating older complex patients with at least one of the following chronic disease: diabetes, hypertension, congestive heart failure, atrial fibrillation and coronary artery disease.

Currently undergoing validation for clinical outcomes.

(Italy)