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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