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Development of quality of care indicators from systematic reviews: the case of hospital delivery

Xavier Bonfill1234*, Marta Roqué24, Marta Beatriz Aller5, Dimelza Osorio1, Carles Foradada36, Àngels Vives7 and David Rigau12

Author Affiliations

1 Service of Clinical Epidemiology, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), c/Sant Quintí 89, Barcelona, 08026, Spain

2 Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain

3 Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine., Universitat Autònoma de Barcelona, Bellaterra, Spain

4 CIBERESP (CIBER de Epidemiología y Salud Pública), Barcelona, Spain

5 Research Unit. Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain

6 Department of Gynaecology and Obstetrics, Corporació Sanitària Parc Taulí, Sabadell, Spain

7 Department of Gynaecology and Obstetrics, Consorci Sanitari de Terrassa, Terrassa, Spain

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Implementation Science 2013, 8:42  doi:10.1186/1748-5908-8-42

Published: 10 April 2013



The objective of this research is to generate quality of care indicators from systematic reviews to assess the appropriateness of obstetric care in hospitals.


A search for systematic reviews about hospital obstetric interventions, conducted in The Cochrane Library, clinical evidence and practice guidelines, identified 303 reviews. We selected 48 high-quality evidence reviews, which resulted in strong clinical recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The 255 remaining reviews were excluded, mainly due to a lack of strong evidence provided by the studies reviewed.


A total of 18 indicators were formulated from these clinical recommendations, on antepartum care (8), care during delivery and postpartum (9), and incomplete miscarriage (1). Authors of the systematic reviews and specialists in obstetrics were consulted to refine the formulation of indicators.


High-quality systematic reviews, whose conclusions clearly claim in favour or against an intervention, can be a source for generating quality indicators of delivery care. To make indicators coherent, the nuances of clinical practice should be considered. Any attempt made to evaluate the extent to which delivery care in hospitals is based on scientific evidence should take the generated indicators into account.

Quality improvement methodologies; Quality indicators; Healthcare; Evidence-based medicine; Obstetrics and gynaecology; Evaluation methodology