A EUROPEAN PERSPECTIVE

Niek Klazinga OECD, Paris AMC/UvA, Amsterdam

• Conceptual Frameworks

• Validity and reliability of quality indicators

• Strengthening the information infrastructure for measuring quality

• Reporting and use of quality measures in practice

The R&D agenda on quality measures

• 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

Conceptual considerations

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

• 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 ……….

Data availability

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

With several national databases Canada,

Malta,

Norway and Switzerland

With 2 national databases Cyprus,

Portugal,

Singapore

None Japan,

Poland,

Germany

Source: OECD HCQI Country Survey, 2011/12

Hosp. in-patient

Prim-ary care

Can-cer reg.

Rx Mort- ality

LT care

Mental hosp. in-patient

National dataset available…

20 16 18 14 20 16 17

Contains a UPI 15 12 14 12 15 11 12

Contains other identifiers

15 12 17 12 17 12 15

Used for data linkage studies

14 10 14 12 16 11 8

Used regularly for data linkage studies to monitor health care quality

12 4 12 7 12 4 5

Too few countries are harnessing value from their

data for performance monitoring

7 Table 1: Number of countries reporting linkable data and reporting data use Source: OECD HCQI Country Survey, 2011/12

8

21 countries use clinical terminology standards for some elements

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Psychosocial or cultural issues

Health behaviours

Physical characteristics

Surgical procedures

Medical image results

Socio-economic information

Laboratory test results

Medications

Diagnosis

All records Some records

9

Health policy brief and

report (2013): http://www.oecd.org/els/health-

systems/strengtheninghealthinform

ationinfrastructure.htm

For more information

Asthma hospital admission in adults, 2006 and

2011 (or nearest year) 1

7

18

n.a

.

18

21

23

21

26

42

32

26

60

n.a

.

44

53

n.a

.

52

n.a

.

42

29

55

55

80

90

96

72

63

12

6

76

11

9

12

2

n.a

.

11

14

15

16

20

21

22

24

28

30

32

35

36

37

37

37

38

39

40

41

46

51

61

61

68

68

69

74

76

10

3

11

7

15

1

0

40

80

120

160

2006 2011Rates per 100 000 population

Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en.

Reduction in case-fatality within 30 days after

admission for AMI, 2001-2011 (or nearest year) 8

.4

8.8

11

.1

8.4

9.4

8.1

9.3

9.1

11

.2

15

.7

13

.3

12

.6

10

.1

10

.3 1

2.4

15

.4

14

.8

12

.5

12

.6

5.1

6.0

6.3

6.0

6.7

7.6

6.4

8.2

7.2

6.9

7.4

7.9

9.2

8.8

9.3

9.3

8.6

8.1

9.1

11

.8

10

.3

9.4

11

.6

9.9

12

.1

10

.8

11

.1

15

.2

12

.9

15

.8

3.0

4.5

4.5

4.5

4.8

5.2

5.5

5.7

5.7

5.8

5.9

6.2

7.9

6.8

6.8

6.8

7.0

7.1

7.6

7.6

7.7

7.8

8.4

8.5

8.8

8.9

8.9

10

.8

12

.2

13

.9

0

5

10

15

20

Rates per 100 admissions 2001 2006 2011

Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en.

Postoperative sepsis in adults,

2011 (or nearest year)

452

998

1135

1207

1226

1791

1651

1182

787

1380

758

1831

1647

2356

n.a.

3027

1539

2763

2749

1460

2995

98

350

366

413

527

603

615

627

657

696

716

732

784

946

964

1026

1052

1068

1121

1427

1667

0 500 1000 1500 2000 2500 3000 3500

Israel

Switzerland

Poland ¹

Belgium

United States

Italy ¹

Canada

Finland ¹

Germany

Denmark

United Kingdom

Norway

OECD (20)

Slovenia

France

Spain

Australia

New Zealand

Portugal

Sweden

Ireland

Rates per 100 000 hospital discharges

Abdominal surgeries All surgeries

Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en.

Breast cancer five-year relative survival, 2001-

2006 and 2006-2011 (or nearest period)

70.2

77.3

76.4

81.8

82.3

82.9

81.8

84.8

82.6

83.1

84.7

84.9

83.7

86.1

85.7

84.4

87.5

86.5

87.5

73.6

80.5

80.7

80.7

82.0

82.6

84.4

84.5

85.0

85.0

85.2

85.6

85.9

85.9

86.1

86.2

86.3

86.4

87.3

87.4

87.7

87.7

89.3

0 20 40 60 80 100

Poland ²

Ireland ¹

Czech Rep. ²

United Kingdom ¹

Denmark ²

Portugal ²

OECD (18)

Austria ²

Belgium ¹

Germany ¹

Korea ¹

Slovenia ¹

Finland ¹

Netherlands ²

Norway ¹

Israel ¹

Sweden ²

New Zealand ¹

Japan ²

Iceland ²*

Australia ¹

Canada ²

United States ²

Age-standardised rates (%)

2006-2011 2001-2006

Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en.

Regular doctor spending enough time with patient

in consultation, 2010 (or nearest year)

74.0

78.0

80.5

81.4

84.1

85.4

86.6

87.1

88.6

91.3

91.5

92.5

92.7

95.5

97.2

0 20 40 60 80 100

Sweden

Norway

Canada

United States

Israel

France

Australia ¹

OECD (14)

United Kingdom

Switzerland

Netherlands

Germany

New Zealand ¹

Luxembourg ¹

Czech Rep. ¹

Age-standardised rates per 100 patients

Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en.

• 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)

Reporting and Using Quality Measures

• Aqua Institut (Germany)

• HAS (France)

• Kwaliteitsinstituut and RIVM (The Netherlands)

• KCE (Belgium)

• Agenas (Italy)

• Socialstyrelsen (Sweden)

• Danish National Indicator Project (Denmark)

European organizations involved in

reporting on quality of health care services

• 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)

EU Funded related research projects

• 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)

The future R&D agenda

• 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