Health Care Quality Indicators

1
Health Care Quality Indicators

• Bridging Health Volume Output and Health Care
  Outcomes
• Niek Klazinga, UvA/OECD

2

• The concept of quality in health care
• OECDs HCQI Project
• Linking quality indicators with volume outputs
  and cost-accounting

3
The concept of quality in Health Care

• Structure, process, outcome
• Quality Domains effectiveness, responsiveness .
• Quality of services versus quality of systems
• Health care helps individuals and populations to
  realize their potential health
• Quality relates to compliance of practices with
  evidence
• Quality relates to health outcomes attributed to
  services

4
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

5
HCQI Foundation
Analysis of available measures and consensus
efforts

• 1. Application of scientific criteria for
  indicators
• Scientific soundness
• Clinical and policy importance
• Feasibility of measurement
• 2. Review balance of measure set
• Structure, process and outcomes

HCQI Initial Measure Set
The Nordic Council of Ministers
6
Streams of work of OECDs HCQI Project

• Regular data collection
• Periodic Update of the set of indicators fit for
  international comparisons
• Ongoing methodological work to improve indicators
  until fit for international comparisons
• New indicator development in 5 priority areas
  establishing specific country expert subgroups.

7
Figure 5. Conceptual framework for Organization
for Economic Cooperation and Development Health
Care Quality Indicator (HCQI) Project. The shaded
area represents the current Focus of the HCQI
Project.
Source Arah OA, et al. A conceptural framework
for the OECD Health Care Quality Indicators
Project. Int J Quality Health Care. 2006 Sep
18 Suppl.15-13.
8

2006 set of HCQI Indicators 2006 set of HCQI Indicators 2006 set of HCQI Indicators
Indicators fit for international comparisons Indicators fit for international comparisons Indicators fit for international comparisons
Outcome measures Outcome measures Implementation measures
Breast Cancer Survival Breast Cancer Survival Mammography Screening
Cervical Cancer Survival Cervical Cancer Survival Cervical Cancer Screening
Colorectal Cancer Survival Colorectal Cancer Survival Coverage for basic vaccination
Incidence of Vaccine Preventable Diseases Incidence of Vaccine Preventable Diseases Waiting time for femur fracture surgery
Asthma mortality rate Asthma mortality rate Influenza vaccination for adults over 65
AMI 30-day case fatality rate AMI 30-day case fatality rate
Stroke 30-day case fatality rate Stroke 30-day case fatality rate
Smoking rates Smoking rates
New Indicators fit for international comparisons New Indicators fit for international comparisons New Indicators fit for international comparisons
Asthma Admission Rate Retinal Exams in diabetics Retinal Exams in diabetics
Indicators NOT fit for international comparisons Indicators NOT fit for international comparisons Indicators NOT fit for international comparisons
Indicators NOT fit YET(New) Indicators STILL NOT fit Indicators STILL NOT fit
Postoperative Hip Fracture or Fall Major Amputations in diabetics Major Amputations in diabetics
Transfusion Reaction HbA1c testing HbA1c testing
Uncontrolled Diabetes Admission Rate Poor glucose control Poor glucose control
Hypertension Admission Rate
9
1. Regular data Collection
10
Draft not for publication
11
Draft not for publication
12
HCQI Progress (1) Publications

• 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, September 2006

13
HCQI Progress (4) New Indicator Development

• Focus initially on patient safety and mental
  health
• Patient Safety
• Dublin seminar - Safety Data for Safer Care -
  First Meeting of the OECD HCQI Patient Safety
  Expert Group
• Co-hosted with Irish Department of Health and
  Children
• Two work initiatives developed and circulated
• Mental health
• Spring 2006 teleconference
• Data questionnaire development Fall 2006
• First Subgroup in-person meeting October 17-18,
  Paris

14
Plans for 2007

• HCQI Special Chapter in Health at a Glance2007
• New indicator development
• Patient safety initiatives in hospital
  administrative data and adverse events systems
  production of 2 working papers -June 2007
• Mental health
• Information collection and framework working
  paper on data and data systems initial working
  paper April 2007
• New indicator working paper November 2007
• Primary care and prevention
• Indicator subgroup launch 2007

15
Linking quality indicators with volume outputs
and cost accounting

• On system level only sensible when a long term
  prevention and disease perspective is taken
  linking the clinical logics model (McGlynn 2004)
  with cost of illness studies
• On services level mainly sensible when using
  ICD9/10 data limited meaningful links with
  DRG-data

16
Bridging Health Volume Output and Health Care
Outcomes

• Using HCQIs for volume output measurement
• Linking HCQIs with functional prevention and
  disease pathways identified in national accounts