Freezing while preserving achievements: suspending quality indicators in healthcare, Israel’s experience

Background: The Israeli National Program for Quality Indicators (INPQ) aims to promote quality health care within selected core areas in Israel. Achieving the national goal for two consecutive years signifies high performance, and suspended indicators allow monitoring performance and individual hospital comparisons while maintaining vigilance against potential performance declines. Our study aimed to analyze the performance of frozen quality indicators, compare their performance, and determine whether the decision to suspend an indicator was justified. Methods: We investigated the INPQ reports from 2013 to 2023, looking for the suspended quality indicators. We examined the percentage of goals achieved for each indicator, the frequency at which the expected goal was met, the number of patients participating in each indicator, and the trend in goal achievement over time. Any significant trends or deviations from the established goals were highlighted. Results: A Pearson correlation coefficient demonstrated a positive correlation between the number of years between reaching the goal and suspension and the number of years from the start of measuring to suspension (R=0.75, P<.0001). An increase of 1% in the indicator achievement before suspension contributed 0.69% on average to the indicator performance a year after suspension (R=0.69, P=.001). The more years the goals were achieved till suspension, the better the achievements continued after suspension (R=3.92, P=.024). Conclusion: Specific strategies to maintain the high performance of suspended indicators should address areas where improvement is needed, considering recommendations for specific categories for individual indicators.