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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
OECD’s Health at a Glance 2005
4
OECD and Health Data : Assessing the costs of services
OECD’s 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 OECD’s 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
Analysis of available measures and consensus efforts
The Nordic Council of Ministers
The Nordic Council of Ministers
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)
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 1a 1b 2 3a 3b 4 5a 5b 6 7 8 9 10 11 12 13a 13b 14 15 16 17
Country/Indicator
Bre
as
t C
an
cer
(ob
s)
Bre
as
t C
an
cer
(re
l)
Ma
mm
og
rap
hy
Ce
rvic
al
Can
ce
r (o
bs
)
Ce
rvic
al
Can
ce
r (r
el)
Ce
rvic
al
Sc
ree
n
Co
lore
cta
l C
an
ce
r (o
bs
)
Co
lore
cta
l C
an
ce
r(re
l)
Inc
ide
nc
e
Va
cc
ins
(p
-m-h
)
Ch
ild
ho
od
V
ac
cin
ati
on
As
thm
a
Mo
rta
lity
AM
I mo
rta
lity
H S
tro
ke
mo
reta
lity
I S
tro
ke
mo
rta
lity
Wa
itin
g t
ime
s fe
mu
r
Dia
be
tes
(t
es
t fo
r H
bA
1c
)
Dia
be
tes
(po
or
glu
co
se c
on
tro
l)
Re
tin
al
Exa
ms
Ma
jor
Am
pu
tati
on
s
Infl
ue
nza
v
ac
cin
s 6
5+
Sm
ok
ing
ra
tes
Australia
Austria
Canada Czech Republic
Denmark
Finland
France
Germany
Iceland
Ireland
Italy
Japan
Mexico
Netherlands
New Zealand
Norway
Portugal
Slovak Republic
Spain
Sweden
Switzerland
United Kingdom
United States
Not suitable for inclusion in initial set
Blank/white cells indicate unavailability of data
16
Results (2) Why Do Differences Exist – Cervical Cancer Example
Five-year Survival for Cervical Cancer
77.6 76.674.0 73.2 73.2 72.0 72.0 72.0 70.7 69.2 67.0 66.0 65.9 64.9 64.0 62.0
55.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
Austra
lia
Icela
nd
Canad
a
New Z
ealan
d
Norway
Switzer
land
United
Kin
gdom
United
Sta
tes
Finlan
d
Sweden
Denm
ark
Germ
any
Franc
e
Japa
nIta
ly
Irelan
d
Nethe
rland
s
Source: OECD HCQI Project
17
Results (3) Why Do Differences Exist – Cervical Cancer Example
Source: OECD HCQI Project
Cervical Cancer 5-year Survival versus Cervical Cancer Screening Rates
R2 = 0.002
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
0 10 20 30 40 50 60 70 80 90 100
% female population 20-69 screened
Ce
rvic
al c
an
ce
r 5
-ye
ar
su
rviv
al r
ate
s
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.pdf
19
Results (6)Heart Disease – AMI Case Fatality Rates
AMI 30 day In-Hospital Case Fatality Rate %
6.5 6.7 6.98 8.8 9.6 10 10.3 10.9 11 11 11.3 11.5 11.9 12 12
1314.8
18
23.1
0
5
10
15
20
25
Country
30
da
y c
as
e f
ata
lity
ra
te (
%)
Source: OECD HCQI Project
20
Results (7)Heart Disease – AMI Case Fatality Rates
AMI Case Fatality Rate vs. Percutaneous Coronary Intervention Rates
R2 = 0.0182
0
50
100
150
200
250
300
350
400
450
0 2 4 6 8 10 12 14 16 18 20
AMI 30-day Case Fatality Rate (%)
PT
CA
per
100
,000
po
p.
Not significantly related
Source: OECD Health Data & HCQI Project
21
Results (8)Heart Disease – AMI Case Fatality Rates
AMI 30-Day Case Fatality Rate vs. % Overweight/Obsese Population
R2 = 0.2741
0
10
20
30
40
50
60
70
0 5 10 15 20 25
AMI 30-Day Case Fatality Rate (%)
% T
ota
l Po
pu
lati
on
wit
h
BM
I>2
5k
g/m
2
Significant relationship (p<.05)
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 OECD’s INES networks in
education Initial subgroup startup
– Patient safety – 2006 – Mental health – 2006– Cardiac care - 2007
25
“Safety Data for Safer Care”First 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 [email protected]+33-1-4524-9239
Web site– OECD Health Care Quality
Indicators – www.oecd.org/health/hcqi