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Measuring health care quality at the international level:
Introduction to the OECD Health Care Quality Indicators Project
Peter SchererHead, Health Division
OECD Patient Safety Seminar – “Safety Data for Safer Care”Dublin – June 29-30, 2006
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Presentation Outline
Purpose and basis for HCQI Project Recent progress Next Steps – Updating Data and Developing
Indicators
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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
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HCQI Foundation
Analysis of available measures and
consensus efforts
The Nordic Council of Ministers
The Nordic Council of Ministers
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
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“Regular” annual 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
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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)
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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?
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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
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Next Steps
Examine differences across countries Improve the indicator set Lay foundation for future indicator
development through country subgroups
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Improving and Updating the Measure Set
Recommendations will be result of work five priority areas selected by OECD countries. – Priority areas: patient safety, mental health care, cardiac care,
diabetes care and primary care and prevention. Expert Subgroups formed in patient safety and mental health
– Subgroup teleconferences held April 2006 (approximately 10-15 countries in each group.)
Major meetings of these groups are planned – Dublin, Ireland June 29-30, 2006; OECD Patient Safety Seminar,
“Safety Data for Safer Care.” – November 2006 OECD’s Mental Health Expert Subgroup.
Similar work is planned in 2007 on cardiac care and diabetes care. Preliminary work has also been begun in 2006 on indicators of
responsiveness.
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Contact information
Dr. Peter SchererHead; Health [email protected]
Dr. Edward KelleyHead, Health Care Quality Indicators [email protected]+33-1-4524-9239
Web site– OECD Health Care Quality
Indicators – www.oecd.org/health
