OECD Health Care Quality Indicator Project

Prague March 5th 2009

Sandra Garcia Armesto on behalf of the HCQI team

Current Streams of Work

1. Regular data collection• Periodic update of a set of indicators suitable for

international comparisons• Ongoing methodological work to improve

international comparability

2. New indicator development in priority areas:• Mental Health Care • Patient Safety • Health Promotion, Prevention and Primary Care• Responsiveness/Patient Experiences

2008-09 HCQI Data Collection“Regular set”Care for acute conditions

Outcome Process

In-hospital AMI case-fatality rates Waiting times for surgery after hip fracture Age 65+

In-hospital ischemic/hemorrhagic stroke case-fatality rates

Cancer care

Outcome Process

5 years-Survival rate for colorectal cancer Mammography screening

5 years-Survival rate for breast cancer Cervical cancer screening

5 years-Survival rate for cervical cancer

Care for chronic conditions

Outcome Process

Hospital admission rate for asthma (people 18+) Annual retina exam for diabetics

Asthma mortality rates (people aged 5-39)

Prevention of communicable diseases

Outcome Process

Incidence of measles Vaccination against measles

Incidence of Pertussis Vaccination against Pertussis (+ diphtheria and tetanus)

Incidence of Hepatitis B Vaccination against Hep. B

Vaccination against influenza (people 65+)

Other

Smoking rates

2008-09 HCQI Data Collection New Indicators

Health Promotion, Prevention and Primary Care Indicators

23. Asthma admission rate

24. COPD admission rate

25. CHF admission rate

26. Angina without procedure admission rate

27. Diabetes short-term complications admission rate

28. Diabetes long-term complications admission rate

29. Uncontrolled diabetes admission rate

30. Diabetes lower extremity amputation rate

31. Hypertension admission rate

Mental Health Care Indicators

32. Unplanned schizophrenia re-admission rate

33. Unplanned bipolar disorder re-admission rate

Patient Safety Indicators

34. Foreign body left during procedure

35. Catheter-related bloodstream infections

36. Post-operative pulmonary embolism or deep vein thrombosis

37. Post-operative sepsis

38. Accidental puncture or laceration

39. Obstetric trauma vaginal delivery with instrument

40. Obstetric trauma vaginal delivery without instrument

Data Sources for Quality Indicators

• Mortality statistics• Vaccination/Infection registries• Cancer registries• Disease specific registries• Administrative Data-bases• Population and Patient based surveys

• OECD HD WP: http://www.oecd.org/els/health/workingpapers

N0.23 Health Care Quality Indicators Project Conceptual Framework Paper 2006No.22 Health Care Quality Indicators Project Initial Indicators Report 2006No.29 Health Care Quality Indicators Project - 2006 data collection update report

2007

• OECD HD TP: http://www.oecd.org/els/health/technicalpapersNo. 20 Information Availability for Measuring and Comparing Quality of Mental

Health Care Across OECD Countries 2008No. 19 Facilitating Cross-National Comparisons of Indicators for Patient Safety at

the Health-System Level in the OECD Countries 2008No. 18 Selecting Indicators for Patient Safety at the Health Systems Level in OECD

Countries 2004No. 17 Selecting Indicators for the Quality of Mental Health Care at the Health

Systems Level in OECD Countries 2004No. 16 Selecting Indicators for the Quality of Health Promotion, Prevention and

Primary Care at the Health Systems Level in OECD Countries 2004No. 15 Selecting Indicators for the Quality of Diabetes Care at the Health Systems

Level in OECD Countries 2004No. 14 Selecting Indicators for the Quality of Cardiac Care at the Health Systems

Level in OECD Countries 2004

Relevant publications

Health at a Glance

• Released every two years • November 2007: Main new feature was

the new chapter on health care quality indicators

• November 2009: Health care quality chapter to be expanded to reflect recent indicator development.

Methodological Improvements agreed upon during the HCQI expert meeting October 2008

• Transparency on the quality of data-sources– representativeness– completeness– regular update– stability of the data source– capability to track patients through the system

• Standardization by age and sex where relevant

Recommendations for Data and Information Systems

• Recording in administrative databases of conditions present at hospital admission

• More detailed recording in administrative databases of secondary diagnoses

• Enhance international comparability of procedures• Implement the use of Unique Patient Identifiers in

national data systems• Establish national information systems for out-of-hospital

care; notably in primary care and mental health care, with similar capacity to generate internationally comparable data as hospital administrative data systems

Work Plan 2009/10

• Data collection 2008/2009 ongoing• Extended Chapter in Health at a Glance 2009• Continuation work in subgroups on safety, primary care

and responsiveness• Start more analytical work to explore differences in

performance and possible relations with the organization and financing of health care (cancer care, cardiovascular diseases)

http://www.oecd.org/els/health/hcqi

Thank you!!!!