Developing and Testing a Set of Quality Indicators for Pharmacist Home Visit Services: A Mixed Methods Study in Japan.

OBJECTIVE Quality indicators (QIs) are an important mechanism by which health services can be evaluated. We aimed to develop a set of QIs for pharmacist home visit services and assess their measurement properties. METHODS A 3-step procedure was applied: 1. Selection of existing content validated QIs from international literature, and development of QIs based on national guidelines and home healthcare professionals' opinions, 2. Expert panel consensus of a preliminary set of QIs using the RAND/UCLA appropriateness technique and 3. Field testing to evaluate their measurement properties (feasibility, applicability, improvement potential, discriminatory capacity, sensitivity to change, acceptability and implementation issues) followed by exploratory semi-structured interviews in Japan. RESULTS Fifty-two preliminary QIs were prepared and 45 were judged as 'appropriate' by the expert panel. Sixty-one community pharmacies were recruited to this study with 41 contributing QI data monthly over the 6-month period. Field testing showed that 20 QIs met 6 measurement properties (i.e. feasibility, applicability, improvement potential, discriminatory capacity, acceptability and implementation issues). Nine of these QIs also had high sensitivity to change. Additionally, interviews identified that the main positive impact on practice of using QIs was the early detection of causes of drug related problems but a negative impact was decrease of pharmacists' motivation. Auto extraction of QIs was seen as a major facilitator, given the time taken to manually extract QI data. CONCLUSIONS A set of QIs for pharmacist home visit services was rigorously developed and tested. This QI set may be useful in evaluating the quality of such services.