The OECD Health Care Quality Indicators Project

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1 The OECD Health Care Quality Indicators Project Ed Kelley, Ph.D. Head, OECD Health Care Quality Indicators Project Health Systems Working Party Luxembourg - April 26,

2 Broad aims of the OECD s HCQI Project To develop a set of key indicators of the quality of health care (including prevention) for strategic international comparisons Confining attention (provisionally) to indicators of the technical quality of health care (=effectiveness) NOT responsiveness (at this stage) NOT disparities/inequities (at this stage) To be population-based, representative of the main disease and risk groups To be targeted at around 50 key indicators 2

3 Proposed conceptual framework Effectiveness of Care Stages of disease Staying healthy Getting better Living with illness and disability Coping with the end of life Concepts of technical quality of healthcare Safety Effectiveness Adapted from the classification matrix proposed by the US Institute of Medicine 3

4 How, in principle, should quality of care be measured (1)? By developing mainly process and outcome indicators of health care Proposed criteria for selecting indicators Importance of what is being measured Impact of disease or risk on health and on health expenditure Policy importance Susceptibility to interventions Scientific soundness of the measure Validity Reliability Explicitness of evidence base 4

5 How, in principle, should quality of care be measured (2)? Proposed criteria for selecting indicators (continued) Feasibility of obtaining internationally comparable data Existence of prototypes Availability of data Cost of measurement/collection 5

6 HQCI Work To-Date Review of conceptual frameworks, and other HCQIs already in use in member countries. Preliminary Report on availability and comparability developed for 17 initial indicators. Expert panels convened to recommend indicators for 5 priority areas (see next) These reports have been released as Health Technical Papers (Numbers 14-18) [ 6

7 Phase 1 Analysis of available measures, e.g.: HCQI Work to Date The Nordic Group Conceptual work, Indicator review Concepts of technical quality of healthcare Phase 2 Full report on broader measure set Safet y Effectiveness St ag es of dis eas e Staying healthy Getting better Living with illness and disability Coping with the end of life 7

8 Indicator Areas Preliminary Report/Phase 1 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) Diabetes control and adverse outcome rates Smoking rates Phase 2 Phase 1 indicators, plus: Promotion, prevention and primary care Mental health care Patient safety Cardiac care (additional indicators) Diabetes care (additional indicators) 8

9 Preliminary Report: Overall data availability is good Ready for publication with minimal work Requiring additional work Currently inadequate data coverage 2. Mammography Screening Rate 3. Cervical Cancer Screening Rate 7. Coverage for basic vaccination program, age Percentage Femur Fractures Operated within 48 Hours 16. Influenza Vaccination for Adults over Smoking Rates 1. Breast Cancer 5- Year Survival 3. Cervical Cancer 5- Year Survival 5. Colorectal Cancer 5- Year Survival 6. Incidence of Vaccine Preventable diseases 8. Asthma Mortality per 100,000 age AMI 30-day Inhospital Case-Fatality Rate 10. Stroke 30-day Inhospital Case-Fatality Rate 14. Retinal Exams in Diabetics 15. Major Amputation in Diabetics 12. Diabetic Patients Tested for HbA1c in last year 13. Diabetic Patients with Poor Glucose Control Australia?? Austria?? Canada T Denmark??? Finland France Germany??? Iceland Ireland Italy Japan Mexico Netherlands??? New Zealand Norway Portugal Spain Sweden???? Switzerland United Kingdom United States

10 .but full comparability is not always given Minor issues: age ranges, time periods Can be dealt with by appropriate footnotes Major issues that can be addressed: Age standardization, inclusion criteria Major issues that cannot be addressed in the short run: data sources, patient vs episode-based calculation, sampling 10

11 Future Work OECD HCQI Work Plan for Work plan approved by the project steering group in October 2004: 2005 Finalizing the Conceptual Framework and Preliminary Report on Phase 1 Measures Starting the process to collect readily available data in the 5 priority areas 2006 Completing collection of available data in 5 priority areas Work with member countries to examine existing data collection on key indicators to improve international data comparability 11

12 Contact Information Ed Kelley, Ph.D (phone) (fax) 12

13 This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.

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