EUPHORIC - A project funded by the European Commission FINAL WORKSHOP 11-12 December 2008
INDICATORS SELECTION AND SHEETS PREPARATION Stefano Rosato
The first phase of the project: SURVEY
The first phase of the project was aimed at defining the tools and the operational conditions necessary to be used in the implementation of the pilot (the second phase of the project).
Aims of the first phase (SURVEY):
• definition of a list of outcome indicators • collection of information from the participating countries about their internal organization in terms of health care system as well as of the health data sources available for the selected outcome indicators • design of a web site and selection of a technological partner
Developing a list of outcome indicators (1)
The starting point was the experience consolidated within the “Outcome measurement” research of the Italian Mattoni Project, launched in 2003 by the Italian Ministry of Health in order to redesign the National Health System. http://www.ministerosalute.it/nsis/pgServizi.jsp?area=mattoni&l anguage=italiano
Developing a list of outcome indicators (2)
The methodological approach adopted in the Italian Outcome Mattoni Project was shared with all the partners. It was decided to update and integrate the first results obtained in Italy taking into account the different contexts of the participating countries
Developing a list of outcome indicators (3)
A set of nine areas of pathology was selected through a deep analysis of international websites and documents concerning experimented collections of indicators.
INSTITUTION
Centre for Health Program Evaluation Australian Health Outcomes Collaboration (AHOC) Australian Council on Healthcare Standards (ACHS) Australasian Association for Quality in Health Care Australia's national agency for health and welfare statistics Australasian Cochrane Centre SPHERe Social and Public Health Economics Research Group Effective Healthcare Australia Health Communication Network (HCN) Commonwealth Department of Health and Ageing (Australia) LinkageWiz Record Linkage Software Centre for Clinical Effectiveness (Monash Institute of Health Services Research) Centre for Clinical Governace Research in Health Western Australian Mental Health Information Development Plan National Centre for Epidemiology and Population Health Australian Longitudinal Study on Women's Health Medical Outcomes Trust Centre for Health Services Research Canadian Institute for Health Information (CIHI) Canadian Institute for Health Information (CIHI) Health Related Quality of Life Mapi Research Institute PROQOLID (Patient Reported Outcome and Quality Of Life Instruments Database) Agency for Quality in Medicine (AQUMED) German Office for Quality Assurance Agency for Quality in Medicine (AQUMED) New Zealand Health Technology Assessment Centre Ministry of Health, New Zeland
WEBSITE
AU AU AU AU AU AU AU AU AU AU AU AU AU AU AU AU AU AU CA CA FR FR DE DE DE NZ NZ http://chpe.buseco.monash.edu.au/main.html http://chsd.uow.edu.au/ahoc/ http://www.achs.org.au www.aaqhc.org.au www.aihw.gov.au/ www.cochrane.org.au www.curtin.edu.au/health/research/sphere www.eha.usyd.edu.au www.hcn.net.au www.health.gov.au www.linkagewiz.com www.med.monash.edu.au/healthservices/cce/ www.med.unsw.edu.au/chmisr www.mhidp.health.wa.gov.au www.nceph.anu.edu.au www.newcastle.edu.au/centre/wha www.outcomes-trust.com www.populationhealth.uwa.edu.au/welcome/research/chsr/chsr http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=pirc_indicators_outco http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=indicators_e www.mapiinstitute.com www.proqolid.org http://www.aezq.de/qualitaetsindikatoren http://www.bqs-qualitaetsindikatoren.de www.aqumed.de/ http://nzhta.chmeds.ac.nz www.moh.govt.nz
INSTITUTION
National Centre for Health Outcomes Development (NCHOD) Clinical Standards Board for Scotland (CSBS) The International Centre for Mental Health Promotion Healthcare Commission NHS Clinical Indicators Support Team - NHS Scotland European Clearing Houses on Health Outcomes National Confidencial Enquiry into Ptient Outcome and Death (NCEPOD) Statistics and performance indicators in healthcare, social services, complaints handling and waiting times Sheffield School of Health and Related Research NHS Centre for Reviews and Dissemination Agency for Health Care Research and Quality (AHRQ) Centers for Medicare & Medicaid Services (CMS) Commonwealth Fund Joint Commission on Accrediation of Healthcare Organizations (JCAHO) National Committee for Quality Assurance (NCQA) The Association of Maryland Hospitals & Health Systems (MHA) National Quality Forum Agency for Health Care Research and Quality (AHRQ) Center for Healthcare Improvement (CHI) Agency for Health Care Research and Quality (AHRQ) Center for Desease Control and Prevention (CDC) Foundation for Accountability National Guidelines Clearinghouse (AHCPR) Pennsylvania Health Care Cost Containment Council Quality Metric OECD World Health Organization
WEBSITE
UK UK UK UK UK UK UK phi.uhce.ox.ac.uk www.clinicalstandards.org www.charity.demon.co.uk www.healthcarecommission.org.uk/homepage.cfm www.indicators.scot.nhs.uk/ www.leeds.ac.uk/nuffield/infoservices/ECHHO/home.html www.ncepod.org.uk/
UK www.performance.doh.gov.uk UK UK USA USA USA USA USA USA USA USA USA USA USA USA USA USA USA www.shef.ac.uk/uni/academic/R www.york.ac.uk/inst/crd/ehcb.htm www.ahrq.gov/chtoolbx/understn.htm www.cms.hhs.gov/MedicaidSCHIPQualPrac/02_evidencebasedcard.asp#Top www.cmwf.org/topics/topics.htm?attrib_id=12010 www.jcaho.org www.ncqa.org www.qiproject.org www.qualityforum.org/ www.qualityindicators.ahrq.gov www.100tophospitals.com/ www.ahrq.gov www.cdc.gov/hrqol/methods.htm www.facct.org www.guidelines.gov www.phc4.org/ www.qmetric.com INT www.oecd.org/dataoecd/1/36/36262363.pdf INT www.who.int/en/
http://www.nhs.uk/Pages/homepage.aspx
Download table of results for all trusts
http://www.qualitymeasures.ahrq.gov/
The selected nine areas of pathology
Cardiovascular disease and surgery Cancer Infectious disease Other chronic disease Orthopaedics Transplantation Emergency Neonatal/maternal Miscellanea
Number of indicators
14 3 6 7 9 5 3 5 2
TOTAL
54
Area Cardiovascular disease and surgery
L I S T O F A L L 5 4 S E L E C T E D I N D I C AT O R S - 1
Emergency readmission to hospital following treatment for a stroke Death within 30 days of admission to hospital with a stroke In-hospital deaths following Coronary Artery Bypass Graft Death within 30 days of Coronary Artery Bypass Graft In-hospital deaths following Percutaneous Transluminal Coronary Angiopl. Death within 30 days of Percutaneous Transluminal Coronary Angioplastic Death within 6 months of Percutaneous Transluminal Coronary Angioplastic Death within 12 months of Percutaneous Transluminal Coronary Angiopl. In-hospital deaths following admission to hospital with AMI Death within 30 days of admission to hospital with an AMI Death within 30 days of admission to hospital with Congestive Heart Failure Hospital admission for Congestive Heart Failure In-hospital deaths and neurological complications following carotid stenting Deaths and neurological complications within 30 days from carotid stenting Emergency admissions of children with lower respiratory infections AIDS survival Death within 30 days of admission to hospital with pneumonia Hospital admissions for paediatric gastroenteritis Hospital admissions for influenza Hospital admissions for tuberculosis Hospital admissions for uncontrolled diabetes Hospital admissions for short term complications of diabetes Hospital admissions for long term complications of diabetes Hospital admissions for lower extremity amputations in patients with diabetes Hospital admissions for adult asthma Hospital admissions for paediatric asthma Hospital admissions for senile asthma
Other chronic disease
Infectious Disease
AREA
Cancer
L I S T O F A L L 5 4 S E L E C T E D I N D I C AT O R S - 2
Breast cancer relative survival Lung cancer relative survival Colon cancer relative survival Emergency readmission to hospital following treatment for a fractured hip Death within 30 days of admission to hospital with a fractured hip In-hospital death following admission with a fractured hip Returning home following hospital treatment for fractured hip In-hospital waiting time for femur fracture surgery Total hip replacement in-hospital mortality rate Partial hip replacement in-hospital mortality rate Revision rate Revision burden rate Medulla ossium graft relative survival Liver transplantation relative survival Heart transplantation relative survival Lung transplantation relative survival Kidney transplantation relative survival Emergency admission to hospital Emergency readmissions to hospital within 28 days Emergency hospital admissions for alcohol related phatologies Maternal mortality rate Neonatal / Infant mortality rate Perinatal mortality rate Perinatal intensive care mortality rate Percentage of births carried out by caesarean section Death within 30 days of surgery (elective and non-elective admissions) Hospital admissions for alcohol related phatologies
Orthopaedics
Transplantation
Emergency Neonatal / Maternal Miscellanea
Following the indications arisen from the “Progetto Mattoni – Misura dell’Outcome” (Mattoni Project – Outcome Evaluation), previously conducted in Italy from 2002 to 2005, for each outcome indicator studied, a sheet containing a number of facts characterizing the indicator was prepared
A standard format has been adopted for the sheet that reports a number of items for each indicator.
A4: Death within 30 days of Coronary Artery Bypass Graft (CABG) - 1
DEFINITION: Rate of deaths occurring (both in hospital and following discharge) within 30 days of a Coronary Artery Bypass Graft (CABG). RATIONALE: It has been fully demonstrated that mortality rate after CABG represents a good indicator of performances in cardio surgery departments as a whole. It has been shown that some deaths are also related to shortcomings in health care. This indicator could be useful in preventing such potentially avoidable deaths by comparing mortality rates of different hospitals/populations and identifying situations where the number of observed deaths results higher/lower than expected.
A4: Death within 30 days of Coronary Artery Bypass Graft (CABG) - 2
NUMERATOR: The number of ordinary admissions with CABG where the patient dies in hospital or after discharge, between 0-29 days (inclusive) after the first eligible procedure
DENOMINATOR: The number of ordinary hospital admissions where CABG was performed
A4: Death within 30 days of Coronary Artery Bypass Graft (CABG) - 3
STATISTICAL METHODS: This indicator is presented at trust and population level. Death rate following CABG procedure may vary between organizations because of many factors. Age, gender and type of procedure (isolated or associated to other procedures CABG). Standardization or stratification is highly recommended to account for at least those aspects of case mix which can be certainly identified.
A4: Death within 30 days of Coronary Artery Bypass Graft (CABG) - 4
HOW TO USE THIS INDICATOR: • for comparative evaluation of hospital performances; • for comparative evaluation between groups of facilities with similar organization and/or process characteristics (i.e. treatment volume, technological equipment); • for comparative evaluation between populations resident in different areas or of different socioeconomic status; • for analysis of trend over time.
A4: Death within 30 days of Coronary Artery Bypass Graft (CABG) – 5
REFERENCES:
• DeBuono BA et al. Cardiac Surgery Reporting System Analysis Workgroup. Coronary Artery By-Pass Surgery in New York State 1994-1996. New York State Department of Health; 1998. • Iezzoni LI, Ash AS, Shwartz M, Daley J, Hughes JS, Mackierman YD. Judging hospitals by severity-adjusted mortality rates: the influence of the severityadjustment method. Am J Public Health 1996;86:1379-87. • Nashef SAM, Roques F, Michel P, Gauducheau E, Lemeshow S, Salomon on the EuroSCORE study group. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999;16:9–13. • New York State Department of Health. Adult Cardiac Surgery in New York State 2000-2002. Albany, NY: New York State Dep of Health; Oct 2004.
The List of outcome indicators on the EUPHORIC website:
http://www.euphoric-project.eu/
Thank You for your attention!