1. How Does the Quality of Care Compare in Five Countries? Peter S. Hussey Johns Hopkins University and the Commonwealth Fund International Working Group on Quality Indicators

2. “Americans have the best health care system in the world”

3. Previous International Comparisons: Little on Clinical Quality WHO OECDWorld Bank

4. Commonwealth Fund International Working Group on Quality Indicators 5-country collaboration –Australia, Canada, New Zealand, the United Kingdom and the United States Representation –Government agencies (AHRQ and its counterparts) –International organizations (OECD, WHO) –Research organizations (IOM, RAND) –Nuffield Trust as cosponsor Directors –Gerard Anderson, Ph.D. –Arnold Epstein, M.D. –Robin Osborn

5. Indicator Selection Criteria Scientific soundness Interpretability Actionability Importance Feasibility

6. Result: 21 Indicators Cancer survival and screening rates Transplant survival rates Heart attack and stroke case-fatality rates Avoidable mortality rates (e.g., asthma) Vaccination rates (flu, polio)

7. Main Findings No country consistently scores best or worst Each country scores highest on at least one indicator Each country scores lowest on at least one indicator

8. Breast Cancer 5-Year Survival US Best Percent of Women Surviving Five Years After Breast Cancer Diagnosis 1992-1997 1993/95-1998/001992-1997

9. 1995-2000 1994/96-1999/011995/96-2000/01 Kidney Transplant Survival US Worst Percent of People Surviving Five Years After a Kidney Transplant

10. Childhood Leukemia 5-Year Survival Canada Best Percent of Children Age 0-14 Surviving Five Years After Leukemia Diagnosis 1992-1997 1991/95-1996/001994-19991992-1998

11. 30-Day Acute Myocardial Infarction Case-Fatality Rate Canada Worst Percent of People Admitted with an AMI Who Die in the Hospital within 30 Days Age-standardized Rate, Age 20-84 (%) Australia7.3 Canada11.1 New Zealand8.8

12. Asthma Mortality Rates Per 100,000 People Age 5-39, 1960-2000 Unexplained Trend Number of Deaths Due to Asthma per 100,000 People Age 5-39 (Age-Standardized)

13. US Conclusion Best of five countries on 4 indicators 2 nd or 3 rd on 10 indicators 4 th or 5 th on 5 indicators Highest spending does not always buy best quality

14. Next Steps More countries More indicators Investigate differences Contact: pete@jhu.edu