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 OECD’s 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 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

5 HCQI Foundation Analysis of available measures and consensus efforts 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

6 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.

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.1:5-13.

set of HCQI Indicators Indicators fit for international comparisons Outcome measures Implementation measures Breast Cancer Survival Mammography Screening Cervical Cancer SurvivalCervical Cancer Screening Colorectal Cancer SurvivalCoverage for basic vaccination Incidence of Vaccine Preventable DiseasesWaiting time for femur fracture surgery Asthma mortality rateInfluenza 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 RateRetinal Exams in diabetics Indicators NOT fit for international comparisons Indicators NOT fit YET(New)Indicators STILL NOT fit Postoperative Hip Fracture or FallMajor Amputations in diabetics Transfusion ReactionHbA1c testing Uncontrolled Diabetes Admission RatePoor 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 HCQI’s for volume output measurement Linking HCQI’s with functional prevention and disease pathways identified in national accounts