1. 1 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

2. 2 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

3. 3 OECD and Health Data : Assessing the amount of services OECDs Health at a Glance 2005

4. 4 OECD and Health Data : Assessing the costs of services OECDs Health at a Glance 2005

5. 5 Quality of services?

6. 6 What is quality?

7. 7 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

8. 8 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)

9. 9 Visualizing Performance…

10. 10 Broad purpose of OECDs 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

11. 11 HCQI Foundation Analysis of available measures and consensus efforts 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)

12. 12 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)

13. 13 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?

14. 14 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

15. 15 Results – Data Availability Not suitable for inclusion in initial set Blank/white cells indicate unavailability of data

16. 16 Results (2) Why Do Differences Exist – Cervical Cancer Example Source: OECD HCQI Project

17. 17 Results (3) Why Do Differences Exist – Cervical Cancer Example Source: OECD HCQI Project

18. 18 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

19. 19 Results (6) Heart Disease – AMI Case Fatality Rates Source: OECD HCQI Project

20. 20 Results (7) Heart Disease – AMI Case Fatality Rates Source: OECD Health Data & HCQI Project

21. 21 Results (8) Heart Disease – AMI Case Fatality Rates Source: OECD Health Data & HCQI Project

22. 22 Next Steps Examine differences across countries Improve the indicator set Lay foundation for future indicator development through country subgroups

23. 23 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)

24. 24 Improving the Indicators – New Indicators Country-led subgroups Modeled on OECDs INES networks in education Initial subgroup startup –Patient safety – 2006 –Mental health – 2006 –Cardiac care - 2007

25. 25 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

26. 26 Contact information Dr. Edward Kelley Head, Health Care Quality Indicators Project OECD edward.kelley@oecd.org +33-1-4524-9239 Web site –OECD Health Care Quality Indicators – www.oecd.org/health/hcqi