Health Care Quality Indicators Project

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Health Care Quality Indicators Project
OECD World Forum on Key Indicators 10th November
2004 Draft 29/10/04
Peter Scherer, Counsellor, Employment and
Social Affairs Directorate, Organisation for
Economic Cooperation and Development
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Outline of Presentation

1. Origins of OECD project
2. Initial indicator collection
3. New Priority Areas
4. Example primary care and prevention panel
5. Concerns about initial panel reports
6. Current work
7. Ministerial endorsement

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1. Origins of OECD Quality Indicators Project

• Inspiration came from work done in Commonwealth
  Fund sponsored project
• In addition, a Nordic network had been formed to
  develop comparable indicators of quality of care.
• OECD proposed that countries in these two
  networks should come together to develop common
  comparable indicators.
• Thus far, 21 countries have participated.

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Goals of the Indicators Project

• To develop a set of internationally-comparable,
  scientifically-valid indicators of the technical
  quality of health care
• This will include
• Assessing the feasibility of collecting
  internationally comparable measures for the
  technical quality of care
• Responding to the need of policy makers to
  measure and benchmark health care system
  performance
• The long term goal is to include some key quality
  indicators in OECD Health Data

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Criteria for good quality indicators

• The overall importance of the aspects of quality
  being measured
• Burden of disease
• Effectiveness of the intervention
• The scientific soundness of the measures
• The feasibility of collecting data on the
  indicators

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2. Initial Collection of Indicators

• At an initial meeting in January 2003, 13
  indicators for initial data collection were
  identified. Most of these were drawn from
  Commonwealth Fund list.
• Preliminary results of this collection of these
  data were presented to second meeting of experts
  in September 2003.
• Experts agreed to modify the list, adding five
  more indicators

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Initial Indicators collected in 2003

• 5-year survival rates, breast cancer (observed
  and relative)
• 5-year survival rates, cervical cancer (observed
  and relative)
• 5-year survival rates, colorectal cancer
  (observed and relative)
• Cervical cancer screening rate, age 20-69, within
  past 3 years
• Asthma mortality rate, ages 5-40
• 30-day mortality rate following acute myocardial
  infarction
• 30-day mortality rate following stroke
• Proportion of diabetics with HbA1c gt 9.5
• Annual HbA1c test for patients with diabetes
• In-hospital waiting time for femur fracture
  surgery
• Proportion of children completing basic
  vaccination program
• Incidence rates for pertussis, measles, hepatitis
  B

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Initial Indicators collected in 2004

• Mammography rates
• Influenza vaccination rates gt65
• Smoking rates
• Rate of retinal exams in diabetics
• Major amputation rates in diabetics
• Data are available for Influenza vaccination
  rates gt65 and Smoking rates through OECD Health
  Data.

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(No Transcript)
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21 Participating Countries

• Australia
• Austria
• Canada
• Denmark
• Finland
• France
• Germany
• Iceland
• Ireland
• Italy
• Japan

• Mexico
• The Netherlands
• New Zealand
• Norway
• Portugal
• Spain
• Sweden
• Switzerland
• United Kingdom
• United States

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Availability of Initial Indicators

• Cancer
• Screening
• Mammography (11)
• Cervical (14)
• 5- Year Survival Rates
• Breast (18)
• Cervical (18)
• Colon (18)
• Health Promotion
• Smoking Rate (20)

• Asthma
• Mortality age 5-39 (18)
• Infectious Disease
• Immunization
• Basic Vaccination age 2 (15)
• Influenza Vaccination over 65 (16)
• Incidence
• Pertussis, Measles and Hepatitis B (19)

Note Number of countries providing data in
parentheses
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Availability of Initial Indicators (cont.)

• Diabetes
• Patients tested for HbA1c in last year (4)
• Patients with poor glucose control (HbA1Cgt9.5)
  in last year (8)
• Retinal exams in diabetics (6)
• Major amputations in diabetics (7)
• Access/Timeliness
• of Femur Fractures operated within 48 hours,
  age 65 or older (4)

• Stroke Care
• 30-day in-hospital case fatality rate for
  hemorrhagic stroke (11)
• 30-day in-hospital case fatality rate for
  ischemic stroke (11)
• Cardiac Care
• 30-day in-hospital case fatality rate for AMI
  (12)

Note Number of countries providing data in
parentheses
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Concerns about initial collection

• At the September 2003 meeting concerns were
  raised about the validity of the collection in
  four respects
• The partial and rather scattered nature of the
  indicators collected.
• The reliability and validity of the data
  themselves.
• The need these concerns implied for a conceptual
  framework to guide this work
• The difficulty for all countries to adhere to
  prescribed definitions (e.g. reference periods--
  three years for cancer screening)
• Some delegates argued that the OECD was in a
  different position to the Commonwealth Fund
• data it releases carry an authority which makes
  it vital that their validity is verified
• These issues will need to be addressed to achieve
  consensus to release the data.

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3. New Priority Areas

• The January 2003 meeting identified five priority
  areas for future development of additional
  indicators
• Cardiac Care
• Diabetes Mellitus,
• Primary Care/Health Prevention and Promotion,
• Patient Safety and
• Mental Health
• Expert Panels were formed to make recommendations
  on suitable and reliable indicators in each of
  these areas
• The reports of the expert panels were circulated
  in first draft at the time of the September 2003
  meeting, and have now been released as OECD
  Health Technical Papers.
• They do not include a detailed investigation of
  availability -- or of the international
  comparability of the available data -- for the
  indicators proposed.

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4. Example OECD Primary Care and Prevention Panel

• Membership
• Professor Sheila Leatherman (US)
• Mr Charlie Hardy (Ireland)
• Professor Niek Klazinga (Netherlands)
• Dr Eckart Bergmann (Germany)
• Dr Luis Pisco (Portugal)
• Dr Jan Mainz (Denmark)
• Professor Martin Marshall (UK)

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Examples of Proposed Primary Care and Prevention
indicators

• Health Promotion
• Obesity prevalence
• Physical activity
• Smoking rate
• Diagnosis and Treatment/Primary Care
• Congestive heart failure readmission rate
• First visit in first trimester
• Smoking cessation counselling for asthmatics
• Blood pressure measurement
• Re-measurement of blood pressure for those with
  high blood pressure
• Initial laboratory investigations for
  hypertension

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Examples of Proposed Primary Care and Prevention
indicators (contd)

• Preventive care
• Blood typing and antibody screening for prenatal
  patients
• Low birthweight rate
• Adolescent immunisation
• Anaemia screening for pregnant women
• Cervical gonorrhoea and Hepatitis B screening for
  pregnant women
• Hepatitis B, influenza and pneumococcal
  immunisation for high-risk groups

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Examples of prevention indicators already in use
in OECD Countries

• Australia
• 57 of women 50-69 get breast cancer screening
  through national programme (likely understatement
  of total)
• objective is 70
• equity of access is also an objective
• United Kingdom
• 69 of women 50-64 get breast ca. screening
• 83 of women 25-64 get cervical ca. screening
• United States
• 62 of smokers get smoking cessation advice at
  routine office visit

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Percentage of hypertensives taking medication
for high blood pressure and health expenditure
per capita
Sources OECD Health Data 2003 and Wolf-Maier, K.
et al. (2003) JAMA 289 2363-2369.
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5. Concerns about Initial Panel Reports

• There remains a need for a clear conceptual
  framework to guide such an ambitious programme
• Concerns about the validity of outcome measures
  against process measures for assessing the
  quality of care
• This issue also arose in formulating the initial
  US AHRQ Report
• A bias towards US or at least English-speaking
  countries sources and measures in some of the
  current panel reports insufficient attention to
  European Union initiatives
• Adjustment of indicators for the risk profile of
  the population
• some experts consider this to be essential.
• others argue that in assessing outcomes one wants
  to know how well a country has adjusted its
  system to the risk profile of its population
  (e.g. heart disease in Finland).

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6. Current Work

• Complete inquiry about data for initial set of 17
  indicators
• Review comparability and availability of initial
  indicators
• Produce paper presenting collected data,
  scientific soundness, policy relevance and
  comparability of each indicator.
• Solicit and integrate written comments of member
  countries into reports on Priority Areas
• Draft initial paper on conceptual framework for
  developing and collecting such indicators.

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7. Ministerial Endorsement

• Health Ministers from OECD countries met for the
  first time at the OECD on 13 and 14 May 2004.
• Meeting chaired by Mexican Secretary for Health,
  with US Secretary and Hungarian Minister as Vice
  Chairs
• They specifically endorsed the programme of work
  on indicators of quality of care, saying

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Ministerial Communiqué

• ... many gaps remain in health data and in
  analysis at the international level.
• We look forward to the OECD increasing the
  importance of its work on health to help fill
  these gaps, as it is centrally placed to provide
  international comparisons and economic analyses
  of health systems. 
• Subject to sufficient resources being made
  available from the regular OECD budget and from
  specific funds, a future OECD work agenda on
  health should
• .....

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Ministerial Communiqué (contd)

• iii. Develop, in collaboration with national
  experts, indicators of the quality of health care
  and indicators of other aspects of health care
  system performance.
• Once consensus on a scientifically-based set of
  reliable indicators has been reached, we should
  endeavour to coordinate different actors and
  levels of government to supply the information in
  a consistent manner.