Author |
_______________________________________ |
Year of publication |
_______________________________________ |
Research location |
_______________________________________ |
Design |
_______________________________________ |
Objective |
_______________________________________ |
Types of sources |
_______________________________________ |
List of indicators used or purposed |
|
1. Indicator name |
_______________________________________ |
2. Description of indicators (numerator and denominator if any) |
_______________________________________ |
3. Indicator objectives |
_______________________________________ |
4. Setting of healthcare facilities |
[] Hospital, [] Primary care, [] Clinic |
5. Type of indicators |
[] Input, [] Process, [] Output |
6. Level of indicators |
[] Patients, [] Institutions, [] Health systems |
7. Quality domain |
_______________________________________ |
8. Validity test |
[] Done, [] None |
Author recommendations |
_______________________________________ |
Reviewer’s note |
_______________________________________ |