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Health Care Quality Indicators

Bridging Health Volume Output and Health Care Outcomes

Niek Klazinga, UvA/OECD

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The concept of quality in health care

OECD’s HCQI – Project

Linking quality indicators with volume outputs and cost-accounting

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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

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Broad Purpose of OECD’s HCQI Broad Purpose of OECD’s HCQI ProjectProject

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

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HCQI FoundationHCQI Foundation

Analysis of available Analysis of available measures and measures and

consensus effortsconsensus efforts

The Nordic Council of Ministers

The Nordic Council of Ministers

1. Application of 1. Application of scientific criteria scientific criteria

for indicatorsfor indicators

Scientific soundness

Clinical and policy importance

Feasibility of measurement

2. Review balance of 2. Review balance of measure setmeasure set

Structure, process and outcomes

HCQI Initial Measure HCQI Initial Measure SetSet

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Streams of work of OECD’s HCQI Project

1. 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

2. New indicator development in 5 priority areas establishing specific country expert subgroups.

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Figure 5. Conceptual frameworkfor Organization for EconomicCooperation and Development Health Care Quality Indicator(HCQI) Project. The shaded area represents the currentFocus 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.1:5-13.

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2006 set of HCQI Indicators

Indicators fit for international comparisons

Outcome measures Implementation measures

Breast Cancer Survival Mammography Screening

Cervical Cancer Survival Cervical Cancer Screening

Colorectal Cancer Survival Coverage for basic vaccination

Incidence of Vaccine Preventable Diseases Waiting time for femur fracture surgery

Asthma mortality rate Influenza vaccination for adults over 65

AMI 30-day case fatality rate

Stroke 30-day case fatality rate

Smoking rates

New Indicators fit for international comparisons

Asthma Admission Rate Retinal Exams in diabetics

Indicators NOT fit for international comparisons

Indicators NOT fit YET(New) Indicators STILL NOT fit

Postoperative Hip Fracture or Fall Major Amputations in diabetics

Transfusion Reaction HbA1c testing

Uncontrolled Diabetes Admission Rate Poor glucose control

Hypertension Admission Rate

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1. “Regular” data Collection

Outcome Measures Implementation Measures Initial Indicator Set

Breast Cancer Survival Mammography Screening Cervical Cancer Survival Cervical Cancer Screening Colorectal Cancer Survival Coverage for basic vaccination Asthma mortality rate Waiting time for femur fracture surgery AMI 30-day case fatality rate Influenza vaccination for adults over 65 Stroke 30-day case fatality rate Smoking rates Incidence of Vaccine Preventable Diseases

Additional Indicator Set (in 2006 collection) Lower extremity amputation rates for diabetics

Annual eye examination for diabetics

Transfusion reaction rate Postoperative hip fracture rate Uncontrolled diabetes admission rate Adult asthma admission rate Hypertension admission rate

10Draft; not for publication

11Draft; not for publication

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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

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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

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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

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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

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Bridging Health Volume Output and Health Care Outcomes

Using HCQI’s for volume output measurement

Linking HCQI’s with functional prevention and disease pathways identified in national accounts