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PLoS One. 2019 Jan 15;14(1):e0210794. doi: 10.1371/journal.pone.0210794. eCollection 2019.

Developing key performance indicators for prescription medication systems.

Author information

Department of Community Health Sciences and O'Brien Institute of Public Health, Calgary, Alberta, Canada.
Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
Department of Medicine, Sinai Health System and University of Toronto, Toronto, Ontario, Canada.
Department of Family Medicine, Bruyère Research Institute, and School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
School of Public Health, Université de Montréal, Montreal, Quebec, Canada.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Medicine University of Alberta, Edmonton, Alberta, Canada.
Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
St Michael's Hospital and University of Toronto, Toronto, Ontario, Canada.
College of Pharmacy and Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Independent Researcher, Ottawa, Onttario, Canada.
Canadian Agency for Drugs and Technology in Health (CADTH), Ottawa, Ontario, Canada.
Schulich Heart Center, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada.



To develop key performance indicators that evaluate the effectiveness of a prescription medication system.


A modified RAND/UCLA appropriateness method was used to develop key performance indicators (KPIs) for a prescription medication system. A broad list of potential KPIs was compiled. A multidisciplinary group composed of 21 experts rated the potential KPIs. A face-to-face meeting was held following the first rating exercise to discuss each potential KPI individually. The expert panel undertook a final rating of KPIs. The final set of KPIs were those indicators where at least 80 percent of experts rated the indicator highly i.e. rating of ≥ 7 on a scale from 1 to 9.


292 KPIs were identified from the published literature. After removing duplicates and combining similar indicators 71 KPIs were included. The final ranking resulted in six indicators being ranked 7 or higher by 80% of the respondents and an additional seven indicators being ranked 7 or higher by ≥70 but ≤80% of respondents. The six selected indicators include four specific disease areas, measure structural and process aspects of health service delivery, and assessed three of the domains of healthcare quality: efficiency, effectiveness, and safety.


These indicators are recommended as a starting point to assess the current performance of prescription medication systems. Consideration should be given to developing indicators in additional disease areas as well as indicators that measure the domains of timeliness and patient-centeredness. Future work should focus on the feasibility of measuring these indicators.

Conflict of interest statement

The authors have declared that no competing interests exist.

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