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Niek Klazinga: A European perspective on care quality

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  • DENMARK AND SWEDEN NOW AGREED AND UNDERWAY
  • Table D16
  • Transcript

    • 1. A EUROPEAN PERSPECTIVE Niek Klazinga OECD, Paris AMC/UvA, Amsterdam
    • 2. The R&D agenda on quality measures • Conceptual Frameworks • Validity and reliability of quality indicators • Strengthening the information infrastructure for measuring quality • Reporting and use of quality measures in practice
    • 3. Conceptual considerations • Quality dimensions: effectiveness, safety, patient centeredness • Functions of the health (care) system • Scope of services and health problems • Population based system perspective • Quality alongside access, appropriateness, efficiency and equity
    • 4. Conceptual Framework for OECD Health Care Quality Indicator (HCQI) Project. (shaded area represents the current focus of the HCQI Project) Source: Arah OA, et al. A conceptual framework for the OECD Health Care Quality Indicators Project. International Journal Quality Health Care. 2006; Sep 18; Suppl.1:5-13. 4
    • 5. Data availability • • • • • Mortality statistics Registries Administrative data-bases Electronic Health Records Surveys • Importance data linkage, use UPI, secondary diagnoses coding, present at admission codes, quality coding, completeness data-sets ……….
    • 6. Country variation National health data linkage projects conducted on a regular basis… Country With many national databases Australia, Belgium, Denmark, Finland, France, Israel, Republic of Korea, Sweden, United Kingdom and Australia Canada, Malta, Norway and Switzerland With several national databases With 2 national databases Cyprus, Portugal, Singapore None Japan, Poland, Germany Source: OECD HCQI Country Survey, 2011/12 6
    • 7. Too few countries are harnessing value from their data for performance monitoring Hosp. Prim- Can- Rx inary cer patient care reg. Mortality LT care Mental hosp. inpatient National dataset 20 available… Contains a UPI 15 16 18 14 20 16 17 12 14 12 15 11 12 Contains other 15 identifiers Used for data 14 linkage studies Used regularly 12 for data linkage studies to monitor health care quality 12 17 12 17 12 15 10 14 12 16 11 8 4 12 7 12 4 5 Table 1: Number of countries reporting linkable data and reporting data use Source: OECD HCQI Country Survey, 2011/12 7
    • 8. 21 countries use clinical terminology standards for some elements 8
    • 9. For more information Health policy brief and report (2013): http://www.oecd.org/els/healthsystems/strengtheninghealthinform ationinfrastructure.htm 9
    • 10. Asthma hospital admission in adults, 2006 and 2011 (or nearest year) Rates per 100 000 population 2006 2011 160 120 80 Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en. n.a. 151 122 117 119 103 76 76 126 74 63 69 72 68 96 68 90 61 80 61 55 51 55 46 29 41 42 40 n.a. 39 52 38 n.a. 37 53 37 44 37 n.a. 36 60 35 26 32 32 30 42 28 26 24 21 22 23 21 21 20 18 16 n.a. 15 18 14 0 17 11 40
    • 11. 0 Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en. 13.9 12.2 10.8 8.9 8.9 8.8 12.6 12.1 12.5 15.8 15.2 14.8 12.9 11.1 10.8 9.9 11.6 15.4 15.7 2006 8.5 8.4 10.3 9.4 12.4 11.8 10.3 9.1 8.1 13.3 12.6 11.2 10.1 8.6 9.3 9.3 8.8 9.2 7.9 7.4 6.9 9.1 9.3 8.2 8.1 7.2 6.4 11.1 9.4 8.4 7.6 6.7 6.0 6.3 8.8 8.4 2001 7.8 7.7 7.6 7.6 7.1 7.0 6.8 6.8 6.8 7.9 6.2 5.9 5.8 5.7 5.7 5.5 5.2 4.8 4.5 4.5 6.0 5.1 5 4.5 3.0 Reduction in case-fatality within 30 days after admission for AMI, 2001-2011 (or nearest year) Rates per 100 admissions 2011 20 15 10
    • 12. Postoperative sepsis in adults, 2011 (or nearest year) Abdominal surgeries All surgeries 452 98 Israel Switzerland Poland ¹ 366 Belgium 998 350 413 United States 1135 1207 1226 527 Italy ¹ 1791 603 1651 Canada 615 Finland ¹ 627 Germany 787 657 Denmark 696 1182 1380 United Kingdom 758 716 Norway 732 OECD (20) 1831 1647 784 Slovenia 2356 946 n.a. France 964 Spain 3027 1026 Australia 1052 New Zealand 1539 1068 Portugal 2763 2749 1121 1460 1427 Sweden Ireland 2995 1667 0 500 1000 1500 2000 2500 3000 Rates per 100 000 hospital discharges Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en. 3500
    • 13. Breast cancer five-year relative survival, 20012006 and 2006-2011 (or nearest period) 2006-2011 2001-2006 89.3 United States ² 87.7 Canada ² 87.5 87.7 Australia ¹ 86.5 Iceland ²* 87.5 87.4 87.3 Japan ² 86.4 New Zealand ¹ 84.4 Sweden ² 85.7 86.3 86.2 Israel ¹ 86.1 Norway ¹ 83.7 Netherlands ² 84.9 Finland ¹ 84.7 Slovenia ¹ 83.1 86.1 85.9 85.9 85.6 85.2 Korea ¹ 82.6 85.0 Germany ¹ 85.0 Belgium ¹ 84.8 84.5 Austria ² 81.8 OECD (18) 82.9 84.4 82.6 Portugal ² 82.3 Denmark ² 81.8 82.0 80.7 United Kingdom ¹ 80.7 Czech Rep. ² 76.4 Ireland ¹ 77.3 80.5 73.6 Poland ² 70.2 0 20 Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en. 40 60 80 100 Age-standardised rates (%)
    • 14. Regular doctor spending enough time with patient in consultation, 2010 (or nearest year) Czech Rep. ¹ 97.2 Luxembourg ¹ 95.5 New Zealand ¹ 92.7 Germany 92.5 Netherlands 91.5 Switzerland 91.3 United Kingdom 88.6 OECD (14) 87.1 Australia ¹ 86.6 France 85.4 Israel 84.1 United States 81.4 Canada 80.5 Norway 78.0 Sweden 74.0 0 20 40 60 80 Age-standardised rates per 100 patients Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en. 100
    • 15. Reporting and Using Quality Measures • Internal/formative and external/summative functions • Evidence on the impact of public reporting • Need to make indicator sets fit for purpose • Indicators as part of and embedded in PDCA cycles (global validity versus local actionability)
    • 16. European organizations involved in reporting on quality of health care services • Aqua Institut (Germany) • HAS (France) • Kwaliteitsinstituut and RIVM (The Netherlands) • KCE (Belgium) • Agenas (Italy) • Socialstyrelsen (Sweden) • Danish National Indicator Project (Denmark)
    • 17. EU Funded related research projects • ECHO (linking administrative databases in six countries and looking at practice variation and hospital outcomes) • EuroHOPE (linking registries from seven countries and looking at outcome indicators) • DuQue (looking at quality improvement in European hospitals in eight countries on process and outcome level)
    • 18. The future R&D agenda • Conceptual robustness • Validity, reliability, relevance and action ability of quality measures • Strengthening the (national) information infrastructures • Evaluation research on reporting and use of quality indicators (from quality watch to quality action)
    • 19. • Health at a Glance 2013 (OECD) forthcoming • Health system performance comparison: New directions in research and policy. • Papanicolas I, Kringos D, Klazinga NS, Smith PC. • Health Policy. 2013 Aug 12. • International comparisons of health system performance among OECD countries: Opportunities and data privacy protection challenges. • Oderkirk J, Ronchi E, Klazinga N. • Health Policy. 2013 Jul 16 • Influences of hospital information systems, indicator data collection and computation on reported Dutch hospital performance indicator scores. • Anema HA, Kievit J, Fischer C, Steyerberg EW, Klazinga NS. • BMC Health Serv Res. 2013 Jun 12;13:212 • Influences of definition ambiguity on hospital performance indicator scores: examples from The Netherlands. • Anema HA, van der Veer SN, Kievit J, Krol-Warmerdam E, Fischer C, Steyerberg E, Dongelmans DA, Reidinga AC, Klazinga NS, de Keizer NF. • Eur J Public Health. 2013 Apr 18. • Measuring and reporting on quality of care and patient safety in Canada: focusing on what matters. • Veillard J, Gula C, Huynh T, Klazinga N. • Healthc Pap. 2012;12(1):32-7; discussion 50-7 • The validity of indicators for assessing quality of care: a review of the European literature on hospital readmission rate. • Fischer C, Anema HA, Klazinga NS. • Eur J Public Health. 2012 Aug;22(4):484-91. doi: 10.1093/eurpub/ckr165. Epub 2011 Dec 2. Review