Health Care Quality Indicators Project Research Articles

Potentially Avoidable Hospitalizations by Asthma and COPD in Switzerland from 1998 to 2018: A Cross-Sectional Study.

Potentially avoidable hospitalizations (PAH) are commonly used as an indicator for healthcare quality and primary care performance. However, data are usually presented in a restricted timeframe and for a specific region, limiting the identification of trends and national patterns. We aimed in this study to calculate rates, identify clinical determinants, and estimate costs of PAH for two frequent lung diseases (asthma and COPD) in Switzerland between 1998 and 2018 using hospital discharge data available for patients aged ≥20 years. PAH were defined according to the Health Care Quality Indicators Project (HCQIP) from the Organisation for Economic Co-operation and Development (OECD). The distribution of PAH in seven administrative regions (Leman, Mittelland, Northwest, Zurich, Eastern, Central, and Ticino) was calculated, along with PAH-associated total hospital days and Diagnosis-Related Group (DRG) estimated costs. Totals of 25,260 PAH for asthma and 135,069 PAH for COPD were identified in the 20-year period. The standardized rates of PAH per 100,000 people for asthma fluctuated from 18.7 in 1998 to 22.5 on 2018. The standardized rates of PAH per 100,000 people from COPD almost doubled from 77.4 in 1998 to 142.7 in 2018. In 2018, the estimated total costs of PAH amounted to 7.7 million CHF for asthma and 91.2 million CHF for COPD. We conclude that PAH for asthma and COPD represent a significant and unnecessary burden and costs of hospitalizations in Switzerland.

Efficiency in health services based on professionals consensus quality indicators

ABSTRACT This study aims to determine the predictive factors of technical efficiency of Organization for Economic Co-operation and Development (OECD) countries according to Health Care Quality Indicators (HCQI) and health status measures. The technical efficiency of OECD countries was analyzed by using data envelopment analysis and different model specifications from 1 to 13. Data was obtained from HCQI project statistics and OECD reports for the years between 2008 and 2011. The technical efficiency of OECD countries according to acute care, primary care, cancer care, cardiovascular diseases, and diabetes and health status measures was determined. The different model specification results indicate that the first model, which includes HCQI, such as primary care, acute care, cancer care, and cardiovascular diseases, as input variables and life expectancy and maternal mortality as output variables have the highest technical efficiency score (79%). The most influential variable that predicts the technical efficiency of OECD countries according to HCQI and health status measures is case fatality in adults within 30 days after admission for acute myocardial infarction (AMI). This study highlights the need to improve diagnostic and treatment technologies of acute care to reduce hospital mortality following AMI to develop quality of health care in developed countries.

Exploiting routine data for international benchmarking of quality in mental health care.

Exploiting routine data for international benchmarking of quality in mental health care.

“Counting the intangible”: The use of evaluation tools and indicators to measure integrated care outcomes in the Basque Country

Introduction : There is currently the debate about how to measure the elements that are key to “successful integrated care”, which are the outcomes that should be achieved and which evaluation tools can be used. The Basque Country has been implementing integrating care policies since 2010. One of the cornerstones of this strategy has been the launch of 13 Integrated Care Organisations (ICOs) to integrate under the same structure Primary and Secondary Care Services (1). Since 2014, changes have been introduced in the metrics of the Contract-Programme (CP) that regulates de relationship between the Ministry of Health (commissioner) and each ICO (health providers). These changes, based on Kelly and Hurst (2), are both qualitative and quantitative and aim to provide the Ministry of Heath with a new framework to evaluate the success of all integrated care policies being implemented. Moreover, one of the new indicators being introduced in the new Contract Programme is IEMAC-ARCHO (3), which is an instrument with 75 items for ICOs to perform a self-assessment in terms of their degree of implementation of chronic care management models and is based on the Chronic Care Model (4). Aims, objectives and results : In this abstract we would like to explore the co-relation in the evolution of the results of both the CP and IEMAC across time. In order to do that we have selected some of the actions/policies behind the new indicators in the CP (see in Figure 1) such as: (i) the provision of case managers and liaison nurses, (ii) systematized agreements with ”outsiders” such as social and community care, (iii) unified health care records, (iv) patient empowerment and participation among others. All these elements aim to improve continuity of care and improve the experience of care across settings. On the other hand in Figure 2 shows the results from 20 evaluations using IEMAC sessions that were conducted with 18 ICOs. Each session was run by health professionals and managers from both levels of care (Primary and Hospital Care) and actors from other areas such as mental health and social care were also represented. The self assessment o IEMAC allows each ICO to identify areas of improvement, define a plan and implement it following what the CP requests. Conclusions : Integrated care is a dynamic process that involves cultural change and measuring that can be rather hard. However evaluation tools are necessary for tracking the evolution of key aspects for integrated care and the various changes that occur when implementing integrated care policies. Looking at the results we can observe a positive evolution of both CP indicators and IEMAC-ARCHO, which indicates good degree of achievement of the policies implemented by the Ministry of Health. In addition to being useful for evaluation purposes, both the CP and IEMAC are powerful tools to identify line of actions and improvement areas that can be supported by the Ministry of Health. References : 1- Toro Polanco N, Berraondo Zabalegui I, Perez Irazusta I, Nuno Solinis R, Del Rio Camara M. Building integrated care systems: a case study of Bidasoa Integrated Health Organisation. International Journal of Integrated Care. 2015;15(2). DOI: http://doi.org/10.5334/ijic.1796 2- Kelley E, Hurts J. Health Care Quality Indicators Project. Conceptual framework Paper. Organization for Economic Co-operation and Development Health Working. Papers No 23, 2006 3- IEMAC. Assessment of Readiness for Chronicity in Heath Care Organisations. [cited 2016 24 Oct] Available from: http://www.iemac.es/internacional.asp 4- Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the Chronic Care Model in the new millennium. Health Aff (Millwood). 2009 Jan-Feb;28(1):75-85

Propensity to seek healthcare in different healthcare systems: analysis of patient data in 34 countries.

BackgroundSome people have a lower threshold to seek care for certain symptoms than others. This study aims to investigate what factors are associated with patients’ propensity to seek care. In addition, this study explores whether patients’ propensity to seek care is associated with their actual health care utilization. We hypothesized that higher scores for propensity to seek care will lead to more general practitioners (GP) consultations, but to lower rates of avoidable hospitalization.MethodsPropensity to seek care and GP utilization were measured by the Patient Experience Questionnaire of the QUALICOPC study, a survey among 61,931 patients that recently visited GP services in 34 countries. Propensity to seek care was estimated by two questions: one question focusing on health care seeking behavior for serious symptoms and the other question focused minor complaints. Data on country level rates of avoidable hospitalization for CHF, COPD, asthma and diabetes were obtained from the OECD health care quality indicators project.ResultsBeside patient characteristics, various organizational factors, such as better accessible and continuous primary care, and better experienced communication between patient and GPs was associated with a higher propensity to seek care for both severe and minor complaints. A higher propensity to seek care was associated with a slightly higher health care utilization in terms of GP visits, with no differences between the severity of the experienced symptoms (OR 1.08 for severe complaints and OR 1.05 for minor complaints). At country level, no association was found between propensity to seek care and rates of avoidable hospitalization for CHF, COPD, asthma and diabetes, possibly due to low statistical power at country level.ConclusionsThe organization of primary care and patients’ perceived communication with their GP were found to be highly correlated with patients’ decision to seek health care for minor or severe complaints, suggesting that characteristics of healthcare systems directly influence patients’ care seeking behavior, potentially leading to overuse or underuse of health services. However, we also observed that patients’ propensity to seek care is only weakly associated with more GP use.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1119-2) contains supplementary material, which is available to authorized users.

How many diagnosis fields are needed to capture safety events in administrative data? Findings and recommendations from the WHO ICD-11 Topic Advisory Group on Quality and Safety.

As part of the WHO ICD-11 development initiative, the Topic Advisory Group on Quality and Safety explores meta-features of morbidity data sets, such as the optimal number of secondary diagnosis fields. The Health Care Quality Indicators Project of the Organization for Economic Co-Operation and Development collected Patient Safety Indicator (PSI) information from administrative hospital data of 19-20 countries in 2009 and 2011. We investigated whether three countries that expanded their data systems to include more secondary diagnosis fields showed increased PSI rates compared with six countries that did not. Furthermore, administrative hospital data from six of these countries and two American states, California (2011) and Florida (2010), were analysed for distributions of coded patient safety events across diagnosis fields. Among the participating countries, increasing the number of diagnosis fields was not associated with any overall increase in PSI rates. However, high proportions of PSI-related diagnoses appeared beyond the sixth secondary diagnosis field. The distribution of three PSI-related ICD codes was similar in California and Florida: 89-90% of central venous catheter infections and 97-99% of retained foreign bodies and accidental punctures or lacerations were captured within 15 secondary diagnosis fields. Six to nine secondary diagnosis fields are inadequate for comparing complication rates using hospital administrative data; at least 15 (and perhaps more with ICD-11) are recommended to fully characterize clinical outcomes. Increasing the number of fields should improve the international and intra-national comparability of data for epidemiologic and health services research, utilization analyses and quality of care assessment.

Application of patient safety indicators internationally: a pilot study among seven countries

To explore the potential for international comparison of patient safety as part of the Health Care Quality Indicators project of the Organization for Economic Co-operation and Development (OECD) by evaluating patient safety indicators originally published by the US Agency for Healthcare Research and Quality (AHRQ). A retrospective cross-sectional study. Acute care hospitals in the USA, UK, Sweden, Spain, Germany, Canada and Australia in 2004 and 2005/2006. Routine hospitalization-related administrative data from seven countries were analyzed. Using algorithms adapted to the diagnosis and procedure coding systems in place in each country, authorities in each of the participating countries reported summaries of the distribution of hospital-level and overall (national) rates for each AHRQ Patient Safety Indicator to the OECD project secretariat. Each country's vector of national indicator rates and the vector of American patient safety indicators rates published by AHRQ (and re-estimated as part of this study) were highly correlated (0.821-0.966). However, there was substantial systematic variation in rates across countries. This pilot study reveals that AHRQ Patient Safety Indicators can be applied to international hospital data. However, the analyses suggest that certain indicators (e.g. 'birth trauma', 'complications of anesthesia') may be too unreliable for international comparisons. Data quality varies across countries; undercoding may be a systematic problem in some countries. Efforts at international harmonization of hospital discharge data sets as well as improved accuracy of documentation should facilitate future comparative analyses of routine databases.

Safety Data for safer care: The importance of international consensus and action

Objective Interest in comparative quality measurement and evaluation has grown considerably over the past two decades due to several factors, such as recognition of widespread variation in clinical practice, the increased availability of evidence on medical effectiveness, and increasing concern about the cost and quality of healthcare. Interest in ensuring that healthcare is safe has grown, particularly since 2001 when the Institute of Medicine (IOM) included patient safety as another quality dimension. This interest in safety is not limited by international borders or by classifications of “more developed” or “less developed” countries. International initiatives at the highest levels of government such as the Organization for Economic Cooperation and Development's (OECD) Health Care Quality Indicators Project and its Patient Safety Working Group, as well as the World Alliance for Patient Safety, highlight the need for international agreement to increase learning on patient safety. However, little is being done to improve the availability and comparability of data/indicators on patient safety within and between countries. Material and method In this paper, we describe the work being done by national bodies such as the US Agency for Healthcare Research and Quality (AHRQ), and international organizations such as the OECD and the World Alliance (WHO) to improve safety data with a view to providing safer care. At the same time, we compare this with information existing in Spain on this same question. Results The proposal by the OECD attempts to identify suitable measurements to enable comparisons at international level, although several difficulties (availability of data, ethical aspects, organization of the systems) mean that the number of indicators has been reduced. The indicators proposed by the AHRQ, based on several solid information sources, offer a much clearer vision as regards patient safety at national level. In Spain, there are initiatives for international comparisons using the indicators proposed by the OECD and, at national level, using the proposals by AHRQ, based on the MBDS (minimum basic data set). Conclusions The development of patient safety data systems, both at national and international level, still has a long way to go. One important aspect to consider, is the need to involve patients and their associations in the collection and recording of data on patient safety.

Claves y retos en la comparación internacional de la seguridad del paciente: la experiencia del health care quality indicators project de la OCDE

This article reviews the work of the Organization for Economic Cooperation and Development (OECD) Healthcare Quality Indicators Project in the field of patient safety indicators. The article reflects on the logic for international comparison of patient safety indicators in addition to offering an analysis of the state of the national information systems linked to the measurement of patient safety across industrialized countries. To finish, a strategy to improve the compa-rability and availability of data both nationally and internationally is outlined. This strategy has a three-pronged approach: a) introduction of patient safety in the national agenda; b) development and expansion of national information systems and registries to improve both the quality and availability of data and enhance comparability across countries; c) establishment of a clear link between information and action.

The OECD Health Care Quality Indicators Project: history and background

To describe the background, history, and approach of the OECD Health Care Quality Indicators (HCQI) Project, an initiative to implement quality measures for international benchmarking of medical care at the health system level. The participating countries and international organizations selected five priority areas (cardiac care, diabetes, mental health, patient safety, and primary care/prevention) and developed a conceptual framework to guide the project. International expert panels were formed to identify clinically important, scientifically sound, and feasible measures based on a structured consensus process. The consensus process was successfully completed in all five priority areas leading to a recommendation of 86 indicators. Nine indicators were selected for diabetes, 12 for mental health, 17 for cardiac care, 21 for patient safety, and 27 for primary care and prevention. The initial experience of the HCQI Project demonstrates that international consensus can be achieved in how to measure the quality of care in priority areas, suggesting substantial demand for and interest in comparative information at the health system level. However, much additional work remains necessary before the project can supply policymakers and researchers with ongoing, comprehensive, and reliable data on the quality of care in industrialized countries.

Beyond the initial indicators: lessons from the OECD Health Care Quality Indicators Project and the US National Healthcare Quality Report

Interest in comparative quality measurement and evaluation has grown considerably over the past two decades because of factors such as the recognition of widespread variation in clinical practice, the increased availability of evidence about medical effectiveness, and increasing concern about the cost and quality of health care. This article describes and contrasts two current efforts to develop health performance reporting systems: one, an international initiative-the Health Care Quality Indicator (HCQI) Project, sponsored by the Organization for Economic Cooperation and Development (OECD); and the other, a national project-the National Healthcare Quality Report (NHQR), sponsored by the US Agency for Healthcare Quality and Research. There are a number of lessons learned from a comparison of the two efforts that are relevant for the future of each project and for other indicator-based reporting efforts in quality of health care. These lessons are discussed in the article and include: Conceptual frameworks should be established to guide the selection of indicators. Choices should be made early on in the process to focus on a wide range of clinical conditions or to report on a few priority areas. should be developed to add and subtract indicators while maintaining a stable set of indicators to track over time. Resources should be allocated to communication strategies and how best to present data results to diverse audiences. Mechanisms should be put in place to maintain project momentum.