1 Measuring health care quality at the international level: Progress in the OECD Health Care Quality Indicators Project Ed Kelley Head, Health Care Quality.

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Measuring health care quality at the international level:

Progress in the OECD Health Care Quality Indicators Project

Ed Kelley

Head, Health Care Quality Indicators Project

Joint OECD/ONS/Government of Norway workshop

Measurement of non-market output in education and health

London – October 3-4, 2006

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Presentation Outline

What is quality and why is it important in health system evaluations?

Purpose and progress for HCQI Project Results from the OECD HCQI Initial

Indicators Report Next Steps – Updating Data and Developing

Indicators

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OECD and Health Data :Assessing the amount of services

OECD’s Health at a Glance 2005

4

OECD and Health Data : Assessing the costs of services

OECD’s Health at a Glance 2005

5

Quality of services?

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What is quality?

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What is Quality?

“…the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge“ (IOM, 1990)

Preference for different treatments (processes) will vary

Outcomes are influenced by many factors other than health care

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Why is Quality Important in Health System Evaluations?

As one measure of a multi-dimension picture of performance– Cost, access, efficiency and equity important dimensions with

quality– Quality is multi-faceted as well – care should be effective, safe

and responsive (or patient centered) As a measure of “value” for money As a measure for adjusting production figures (length of

stay, staff-to-patient ratios, etc.) As an indirect measure of efficiency (e.g. avoidable

hospitalizations)

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Visualizing Performance…

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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

HCQI Initial Indicator Set Cancer screening rates and

survival Vaccination rates for children

and elderly Mortality rates for asthma, heart

attack and stroke Waiting times for surgery (hip

fracture) Smoking rates Diabetes control and adverse

outcome rates (not included in final indicator set)

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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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Results – Data Availability 1a 1b 2 3a 3b 4 5a 5b 6 7 8 9 10 11 12 13a 13b 14 15 16 17

Country/Indicator

Bre

as

t C

an

cer

(ob

s)

Bre

as

t C

an

cer

(re

l)

Ma

mm

og

rap

hy

Ce

rvic

al

Can

ce

r (o

bs

)

Ce

rvic

al

Can

ce

r (r

el)

Ce

rvic

al

Sc

ree

n

Co

lore

cta

l C

an

ce

r (o

bs

)

Co

lore

cta

l C

an

ce

r(re

l)

Inc

ide

nc

e

Va

cc

ins

(p

-m-h

)

Ch

ild

ho

od

V

ac

cin

ati

on

As

thm

a

Mo

rta

lity

AM

I mo

rta

lity

H S

tro

ke

mo

reta

lity

I S

tro

ke

mo

rta

lity

Wa

itin

g t

ime

s fe

mu

r

Dia

be

tes

(t

es

t fo

r H

bA

1c

)

Dia

be

tes

(po

or

glu

co

se c

on

tro

l)

Re

tin

al

Exa

ms

Ma

jor

Am

pu

tati

on

s

Infl

ue

nza

v

ac

cin

s 6

5+

Sm

ok

ing

ra

tes

Australia

Austria

Canada Czech Republic

Denmark

Finland

France

Germany

Iceland

Ireland

Italy

Japan

Mexico

Netherlands

New Zealand

Norway

Portugal

Slovak Republic

Spain

Sweden

Switzerland

United Kingdom

United States

Not suitable for inclusion in initial set

Blank/white cells indicate unavailability of data

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Results (2) Why Do Differences Exist – Cervical Cancer Example

Five-year Survival for Cervical Cancer

77.6 76.674.0 73.2 73.2 72.0 72.0 72.0 70.7 69.2 67.0 66.0 65.9 64.9 64.0 62.0

55.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Austra

lia

Icela

nd

Canad

a

New Z

ealan

d

Norway

Switzer

land

United

Kin

gdom

United

Sta

tes

Finlan

d

Sweden

Denm

ark

Germ

any

Franc

e

Japa

nIta

ly

Irelan

d

Nethe

rland

s

Source: OECD HCQI Project

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Results (3) Why Do Differences Exist – Cervical Cancer Example

Source: OECD HCQI Project

Cervical Cancer 5-year Survival versus Cervical Cancer Screening Rates

R2 = 0.002

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

0 10 20 30 40 50 60 70 80 90 100

% female population 20-69 screened

Ce

rvic

al c

an

ce

r 5

-ye

ar

su

rviv

al r

ate

s

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Results (4) Why Do Differences Exist – Cervical Cancer Example

Screening – Research in Australia (NSW) - survival/screening relationship in earlier data (1980s trends)

SES - Research in US and Japan - SES persistent influence on cervical cancer survival across races and over time

Source: US SEER Survival Statistics, http://seer.cancer.gov/publications/ses/survival.pdf

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Results (6)Heart Disease – AMI Case Fatality Rates

AMI 30 day In-Hospital Case Fatality Rate %

6.5 6.7 6.98 8.8 9.6 10 10.3 10.9 11 11 11.3 11.5 11.9 12 12

1314.8

18

23.1

0

5

10

15

20

25

Country

30

da

y c

as

e f

ata

lity

ra

te (

%)

Source: OECD HCQI Project

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Results (7)Heart Disease – AMI Case Fatality Rates

AMI Case Fatality Rate vs. Percutaneous Coronary Intervention Rates

R2 = 0.0182

0

50

100

150

200

250

300

350

400

450

0 2 4 6 8 10 12 14 16 18 20

AMI 30-day Case Fatality Rate (%)

PT

CA

per

100

,000

po

p.

Not significantly related

Source: OECD Health Data & HCQI Project

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Results (8)Heart Disease – AMI Case Fatality Rates

AMI 30-Day Case Fatality Rate vs. % Overweight/Obsese Population

R2 = 0.2741

0

10

20

30

40

50

60

70

0 5 10 15 20 25

AMI 30-Day Case Fatality Rate (%)

% T

ota

l Po

pu

lati

on

wit

h

BM

I>2

5k

g/m

2

Significant relationship (p<.05)

Source: OECD Health Data & HCQI Project

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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

Updating Linking HCQI indicators

with OECD Health Data HCQI 2006

Questionnaire in field currently (until July 2006)

Updating data on initial 13 indicators

Improving Seven new indicators

– Diabetes control and adverse outcome rates

– Preventable hospitalizations

– Initial patient safety indicators (ventilator associated pneumonia, in-hospital hip fractures)

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Improving the Indicators – New Indicators

Country-led subgroups Modeled on OECD’s INES networks in

education Initial subgroup startup

– Patient safety – 2006 – Mental health – 2006– Cardiac care - 2007

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“Safety Data for Safer Care”First Meeting of the OECD HCQI Patient Safety

Expert Group June 29-30, 2006 Dublin, Ireland Co-hosted with Irish Department

of Health and Children Purposes:

– Review barriers and propose solutions to PS international data comparability

– Discuss issues in getting PS data systems on the agenda

– Open dialogue on international harmonization on PS indicators

Agenda & info available from OECD

Featured speakers:– Deputy Prime Minister Mary

Harney, Government of Ireland– Sir Liam Donaldson, World

Alliance for Patient Safety and UK Chief Medical Officer

– Dr. Carolyn Clancy, Director, US Agency for Healthcare Research and Quality

– Mr. Michael Scanlan, Secretary General, Irish Department of Health and Children

– Dr. Jim Kiley, Chief Medical Officer, Ireland

– Experts from EC, WHO-Euro and lead patient safety organizations in Canada, Sweden, Ireland, Spain, Italy and the UK

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Contact information

Dr. Edward KelleyHead, Health Care Quality Indicators [email protected]+33-1-4524-9239

Web site– OECD Health Care Quality

Indicators – www.oecd.org/health/hcqi