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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

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

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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 framework
for Organization for Economic
Cooperation and Development
Health Care Quality Indicator
(HCQI) Project. The shaded
area represents the current
Focus of the HCQI Project.
Source: Arah OA, et al. A conceptural framework
for the OECD Health Care Quality Indicators
Project. Int J Quality Health Care. 2006; Sep 18;
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
diabetics
Annual eye examination for 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

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Draft; not for publication

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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

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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