Title: Measuring health care quality at the international level: Progress in the OECD Health Care Quality Indicators Project
1Measuring health care quality at the
international level Progress in the OECD
Health Care Quality Indicators Project
- Ed Kelley
- Head, Health Care Quality Indicators Project
- Joint OECD/ONS/Government of Norway workshop
- Measurement of non-market output in education and
health - London October 3-4, 2006
-
2Presentation Outline
- What is quality and why is it important in health
system evaluations? - Purpose and progress for HCQI Project
- Results from the OECD HCQI Initial Indicators
Report - Next Steps Updating Data and Developing
Indicators
3OECD and Health Data Assessing the amount of
services
- OECDs Health at a Glance 2005
4OECD and Health Data Assessing the costs of
services
- OECDs Health at a Glance 2005
5Quality of services?
6What is quality?
7What is Quality?
- the degree to which health services for
individuals and populations increase the
likelihood of desired health outcomes and are
consistent with current professional knowledge
(IOM, 1990) - Preference for different treatments (processes)
will vary - Outcomes are influenced by many factors other
than health care
8Why is Quality Important in Health System
Evaluations?
- As one measure of a multi-dimension picture of
performance - Cost, access, efficiency and equity important
dimensions with quality - Quality is multi-faceted as well care should be
effective, safe and responsive (or patient
centered) - As a measure of value for money
- As a measure for adjusting production figures
(length of stay, staff-to-patient ratios, etc.) - As an indirect measure of efficiency (e.g.
avoidable hospitalizations)
9Visualizing Performance
10Broad purpose of OECDs HCQI Project
- Develop indicator set - to raise questions
about quality of health care across countries - Initial attention - technical quality of health
care (i.e. effectiveness) - Future consideration of other areas (e.g.
Responsiveness/patient centeredness) - To be representative of the main disease and risk
groups in participating countries
11HCQI Foundation
- HCQI Initial Indicator Set
- Cancer screening rates and survival
- Vaccination rates for children and elderly
- Mortality rates for asthma, heart attack and
stroke - Waiting times for surgery (hip fracture)
- Smoking rates
- Diabetes control and adverse outcome rates (not
included in final indicator set)
Analysis of available measures and consensus
efforts
The Nordic Council of Ministers
12HCQI Progress
- Project reports and dissemination -
- OECD Health Working Paper 22 HCQI Initial
Indicators Report (2006) - OECD Health Working Paper 23 HCQI Conceptual
Framework Paper (2006) - International Journal for Quality in Health Care
HCQI supplement, Fall 2006 - European Conference on Health Economics,
Budapest, Hungary (2006) - European Health Forum, Gastein, Austria (2005)
- International Scientific Basis of Health
Services, Montreal, Canada (2005) - UK EU Presidency Summit on Patient Safety,
London, UK (2005)
13HCQI Initial Indicators Report Data
Comparability Analyses
- Data comparability questions investigated
- What is the appropriate reference population for
age adjustment? - What is the impact of different policies for
handling missing data? - What is the impact of notification policies on
cases of vaccine-preventable disease? - What is the impact of variation in coding
practices (for asthma)? - What is the effect of unique identifiers when
dealing with mortality rates?
14Results from the HCQI Initial Indicators Report
- No country best or worst in all indicators
- Most countries exhibit areas of possible best
practices - All indicators raise questions for possible
future investigation about why differences in
quality exist
15Results Data Availability
Blank/white cells indicate unavailability of data
Not suitable for inclusion in initial set
16Results (2) Why Do Differences Exist Cervical
Cancer Example
Source OECD HCQI Project
17Results (3) Why Do Differences Exist Cervical
Cancer Example
Source OECD HCQI Project
18Results (4) Why Do Differences Exist Cervical
Cancer Example
- Screening Research in Australia (NSW) -
survival/screening relationship in earlier data
(1980s trends) - SES - Research in US and Japan - SES
persistent influence on cervical cancer survival
across races and over time
Source US SEER Survival Statistics,
http//seer.cancer.gov/publications/ses/survival.p
df
19Results (6)Heart Disease AMI Case Fatality
Rates
Source OECD HCQI Project
20Results (7)Heart Disease AMI Case Fatality
Rates
Source OECD Health Data HCQI Project
21Results (8)Heart Disease AMI Case Fatality
Rates
Source OECD Health Data HCQI Project
22Next Steps
- Examine differences across countries
- Improve the indicator set
- Lay foundation for future indicator development
through country subgroups
23Improving and Updating the Measure Set
- Updating
- Linking HCQI indicators with OECD Health Data
- HCQI 2006 Questionnaire in field currently (until
July 2006) - Updating data on initial 13 indicators
- Improving
- Seven new indicators
- Diabetes control and adverse outcome rates
- Preventable hospitalizations
- Initial patient safety indicators (ventilator
associated pneumonia, in-hospital hip fractures)
24Improving the Indicators New Indicators
- Country-led subgroups
- Modeled on OECDs INES networks in education
- Initial subgroup startup
- Patient safety 2006
- Mental health 2006
- Cardiac care - 2007
25Safety Data for Safer CareFirst Meeting of the
OECD HCQI Patient Safety Expert Group
- June 29-30, 2006
- Dublin, Ireland
- Co-hosted with Irish Department of Health and
Children - Purposes
- Review barriers and propose solutions to PS
international data comparability - Discuss issues in getting PS data systems on the
agenda - Open dialogue on international harmonization on
PS indicators - Agenda info available from OECD
- Featured speakers
- Deputy Prime Minister Mary Harney, Government of
Ireland - Sir Liam Donaldson, World Alliance for Patient
Safety and UK Chief Medical Officer - Dr. Carolyn Clancy, Director, US Agency for
Healthcare Research and Quality - Mr. Michael Scanlan, Secretary General, Irish
Department of Health and Children - Dr. Jim Kiley, Chief Medical Officer, Ireland
- Experts from EC, WHO-Euro and lead patient safety
organizations in Canada, Sweden, Ireland, Spain,
Italy and the UK
26Contact information
- Dr. Edward KelleyHead, Health Care Quality
Indicators ProjectOECDedward.kelley_at_oecd.org33
-1-4524-9239
- Web site
- OECD Health Care Quality Indicators
www.oecd.org/health/hcqi