Health Care Quality Indicators • Bridging Health Volume Output and Health Care Outcomes • Niek Klazinga, UvA/OECD
The concept of quality in health care • OECD’s HCQI – Project • Linking quality indicators with volume outputs and cost-accounting
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
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
HCQI Foundation Analysis of available measures and consensus efforts 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 The Nordic Council of Ministers
Streams of work of OECD’s HCQI Project • 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 • New indicator development in 5 priority areas establishing specific country expert subgroups.
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.
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
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
Plans for 2007 • HCQI Special Chapter in Health at a Glance2007 • New indicator development: • Patient safetyinitiatives 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
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
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