Health Care Quality Indicators by liuqingyan

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									         Health Care Quality Indicators

   Bridging Health Volume Output and Health Care
    Outcomes




   Niek Klazinga, UvA/OECD


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   The concept of quality in health care

   OECD’s HCQI – Project

   Linking quality indicators with volume outputs and
    cost-accounting




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    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

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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



                                                      4
                        HCQI Foundation
Analysis of available         1. Application of      HCQI Initial Measure
   measures and                scientific criteria           Set
 consensus efforts               for indicators
                              Scientific
                              soundness
                              Clinical and policy
                              importance
                             Feasibility of
                              measurement
    The Nordic            2. Review balance of
    Council of                 measure set
     Ministers
                             Structure, process
                              and outcomes



                                                                  5
          Streams of work of OECD’s HCQI Project


1.       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
2.       New indicator development in 5 priority areas
         establishing specific country expert subgroups.




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Figure 5. Conceptual framew
for Organization for Econom
Cooperation and Developme
Health Care Quality Indicato
(HCQI) Project. The shaded
area represents the current
Focus of the HCQI Project.




Source: Arah OA, et al. A conceptural frame
for the OECD Health Care Quality Indicators
Project. Int J Quality Health Care. 2006; Sep
Suppl.1:5-13.
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2006 set of HCQI Indicators
Indicators fit for international comparisons
Outcome measures                                                      Implementation measures
Breast Cancer Survival                                                Mammography Screening
Cervical Cancer Survival                                             Cervical Cancer Screening
Colorectal Cancer Survival                                           Coverage for basic vaccination
Incidence of Vaccine Preventable Diseases                            Waiting time for femur fracture surgery

Asthma mortality rate                                                Influenza vaccination for adults over 65
AMI 30-day case fatality rate
Stroke 30-day case fatality rate
Smoking rates
New Indicators fit for international comparisons
Asthma Admission Rate                                        Retinal Exams in diabetics
                                            Indicators NOT fit for international comparisons
Indicators NOT fit YET(New)                                  Indicators STILL NOT fit
Postoperative Hip Fracture or Fall                           Major Amputations in diabetics
Transfusion Reaction                                         HbA1c testing
Uncontrolled Diabetes Admission Rate                         Poor glucose control
Hypertension Admission Rate




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             1. “Regular” data Collection

          Outcome Measures              Implementation Measures
                        Initial Indicator Set
Breast Cancer Survival                      Mammography Screening
Cervical Cancer Survival                    Cervical Cancer Screening
Colorectal Cancer Survival                  Coverage for basic vaccination
Asthma mortality rate                       Waiting time for femur fracture surgery
AMI 30-day case fatality rate               Influenza vaccination for adults over 65
Stroke 30-day case fatality rate            Smoking rates
Incidence of Vaccine Preventable Diseases
                  Additional Indicator Set (in 2006 collection)
Lower extremity amputation rates for        Annual eye examination for diabetics
diabetics
Transfusion reaction rate
Postoperative hip fracture rate
Uncontrolled diabetes admission rate
Adult asthma admission rate
Hypertension admission rate


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Draft; not for publication   10
                             11
Draft; not for publication
                       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




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                         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




                                                                         13
                              Plans for 2007
   HCQI Special Chapter in Health at a Glance2007
   New indicator development:
     – Patient safety initiatives 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




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    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




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     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




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