Open Access Highly Accessed Research article

Suitability of three indicators measuring the quality of coordination within hospitals

Etienne Minvielle1*, Henri Leleu1, Frédéric Capuano1, Catherine Grenier2, Philippe Loirat1 and Laurent Degos3

Author Affiliations

1 Coordination for Measuring Performance Assuring Quality in Hospitals (COMPAQH), CERMES and Institut Gustave Roussy, INSERM (U988), 39, rue Camille Desmoulins 94805 Villejuif cedex, France

2 Department of Quality, French Federation of Centre for Cancer (FNCLCC), 101, rue de Tolbiac - 75654 Paris Cedex 13, France

3 High Authority for Health (HAS- Haute Autorité de Santé), 2, avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France

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BMC Health Services Research 2010, 10:93  doi:10.1186/1472-6963-10-93

Published: 8 April 2010



Coordination within hospitals is a major attribute of medical care and influences quality of care. This study tested the validity of 3 indicators covering two key aspects of coordination: the transfer of written information between professionals (medical record content, radiology exam order) and the holding of multidisciplinary team meetings during treatment planning.


The study was supervised by the French health authorities (COMPAQH project). Data for the three indicators were collected in a panel of 30 to 60 volunteer hospitals by 6 Clinical Research Assistants. The metrological qualities of the indicators were assessed: (i) Feasibility was assessed using a grid of 19 potential problems, (ii) Inter-observer reliability was given by the kappa coefficient () and internal consistency by Cronbach's alpha test, (iii) Discriminatory power was given by an analysis of inter-hospital variability using the Gini coefficient as a measure of dispersion.


Overall, 19281 data items were collected and analyzed. All three indicators presented acceptable feasibility and reliability (, 0.59 to 0.97) and showed wide differences among hospitals (Gini, 0.08 to 0.11), indicating that they are suitable for making comparisons among hospitals.


This set of 3 indicators provides a proxy measurement of coordination. Further research on the indicators is needed to find out how they can generate a learning process. The medical record indicator has been included in the French national accreditation procedure for healthcare organisations. The two other indicators are currently being assessed for inclusion.