I'd say performance is most frequently defined in terms of how much useful work is done per time unit. From that point of view neither BP hit ratio nor index utilization are indicative. One would need to find where most time is being spent, and try to improve that. It could be physical I/O, sorts, lock waits, query compilation, etc. Once the bottleneck is known, you can determine possible solutions and, at that point, appropriate metrics to verify them.