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Measuring health care quality at the international level: Progress in the OECD Health Care Quality Indicators Project

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Title: Measuring health care quality at the international level: Progress in the OECD Health Care Quality Indicators Project


1
Measuring 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

2
Presentation 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

3
OECD and Health Data Assessing the amount of
services
  • OECDs Health at a Glance 2005

4
OECD and Health Data Assessing the costs of
services
  • OECDs Health at a Glance 2005

5
Quality of services?
6
What is quality?
7
What 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

8
Why 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)

9
Visualizing Performance
10
Broad 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

11
HCQI 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
12
HCQI 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)

13
HCQI 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?

14
Results 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

15
Results Data Availability
Blank/white cells indicate unavailability of data
Not suitable for inclusion in initial set
16
Results (2) Why Do Differences Exist Cervical
Cancer Example
Source OECD HCQI Project
17
Results (3) Why Do Differences Exist Cervical
Cancer Example
Source OECD HCQI Project
18
Results (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
19
Results (6)Heart Disease AMI Case Fatality
Rates
Source OECD HCQI Project
20
Results (7)Heart Disease AMI Case Fatality
Rates
Source OECD Health Data HCQI Project
21
Results (8)Heart Disease AMI Case Fatality
Rates
Source OECD Health Data HCQI Project
22
Next Steps
  • Examine differences across countries
  • Improve the indicator set
  • Lay foundation for future indicator development
    through country subgroups

23
Improving 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)

24
Improving 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

25
Safety 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

26
Contact 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
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