Academic Health

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Academic Health

• Sunday June 6, 2004
• Dr John Millar
• San Diego

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Commonwealth Fund International Health Care
Indicators Project
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Commonwealth Fund (CMWF)

• Independent, endowed foundation based in NY
• 4 years ago invited representatives of 5
  English-speaking countries to come together to
  consider the development of comparable
  international indicators of health care system
  performance.
• Arose from a desire to
• be able to compare health care system
  performance,
• learn from other countries
• support quality improvement
• determine value for money

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CMWF Processes Outputs

• Conducts surveys of health care system access
  responsiveness
• Reports on health care system performance and
  expenditures
• Convenes meetings of the 5 Ministers of Health to
  discuss health policy

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CMWF International Working Group on Quality
Indicators

• Chair Dr Arnie Epstein (Harvard School of Public
  Health),
• Representatives from Australia, Canada, New
  Zealand, UK, US, OECD, WHO, RAND, Nuffield,
  CCHSA, IOM
• Coordinated by Robin Osborne, Peter Hussey and
  Gerry Anderson

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The Process

• Commonwealth Fund
• Framework
• Sources of indicators
• Selection criteria
• Selection process

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Framework -CIHI
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(No Transcript)
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Sources

• Australian Institute of Health Welfare
• Canadian Institute for Health Information
• Commonwealth Fund
• OECD
• Agency for Health Research Quality (US)
• National Committee for Quality Assurance (US)
• National Health Service (UK)
• NCHS (US)
• NZ Health Information Service
• WHO

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(No Transcript)
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The CMWF Indicators

• Breast cancer screening
• Breast cancer 5 yr survival rates
• Cervical cancer screening
• Cervical cancer 5 yr survival rates
• Colorectal cancer survival rates
• Childhood leukemia 5 yr survival
• Non-Hodgkins lymphoma 5 yr survival

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• Kidney transplant 5 yr survival
• Liver transplant 5 yr survival
• AMI 30 day case-fatality rate
• Ischemic stroke 30 day case-fatality
• Hemorrhagic stroke 30 d case-fatality
• Asthma mortality rate (age 5-39)
• Smoking rate

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• ESRD for diabetics (may drop)
• Amputation rates in diabetics (major-may add)
• HB A1C in diabetics(may add)
• Suicide rates
• Vaccination rates influenza
• Vaccination rate polio (may drop)
• Incidence of vaccine-preventable diseases

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Accessibility/Acceptability

• Difficulty seeing a specialist
• Difficulty getting care on nights and weekends
• Waiting time to see a doctor
• Waiting time for emergency care
• Waiting time for elective surgery
• Financial barriers to care
• Patient-doctor communication

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Results???

• No one country emerges as the best all excel
  in some areas and could make better progress in
  others
• Some countries already using the data for CQI
  purposes

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The Canadian Experience

• Academic Health
• San Diego
• June 6,2004

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Health Information in Canada

• Responsibility for health information largely
  transferred to non-government organisations
  (provincial/federal disputes distrust)
• Statistics Canada Health Canada
• Canadian Institute for Health Information
• Canada Health Infoway
• National Health Council
• Patient Safety Institute
• Canadian Public Health Agency Chief Public
  Health Officer

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Use of health data

• Accountability First Ministers, provincial
  performance agreements with regional health
  authorities
• Performance improvement (CQI)
• Planning, management, policy, decision support
• Evaluation, research, teaching
• Public info, knowledge (market share)
• Clinical decision-making

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Reaction to Commonwealth Report

• Canada bad place to have a heart attack
• Given ½ US expenditures better or similar on
  most objective measures, encouraging
• More objective assessment of performance than
  reports using measures unrelated to performance
  or biased data
• Academic interest in exploring differences