Health System Performance Measurement Research Articles

Role of prescribers in the level of patient satisfaction: A study in public health care settings

To assess the level of patient satisfaction with the various aspects of interaction of the health provider with the patient such as communication, examination and information regarding prescription in the allopathic public health facilities of Lucknow district. Public health facilities of Lucknow district, India. Satisfaction in service provision is increasingly being used as a measure of health system performance. The satisfaction with the service provider i.e., the prescriber is a vital component of the whole process of consultation and largely determines the compliance of the patient to the treatment prescribed. Apart from this, satisfaction also varies according to the sociodemographic characteristics of the beneficiaries. We have therefore tried to study these factors in the present study. Multistage stratified random sampling was used to select the health facilities while the patients were selected by systematic random sampling for the interview. Number and percentages, mean and χ(2) test. The overall satisfaction regarding the doctor patient communication and certain aspects of examination was highest for the residents (75.4%) followed by the super specialists (71.5%) and specialists (69.1%). The findings of the study will help us educate the prescribers about the various neglected areas of the consultation which will go a long way to develop a consistent relationship between the providers and the beneficiaries for the attainment of the "Health for All".

'Avoidable' mortality: a measure of health system performance in the Czech Republic and Slovakia between 1971 and 2008

BACKGROUND Post-communist health care reforms and the break-up of Czechoslovakia have been studied from various perspectives, but little research has addressed the impact on health system performance. This paper investigates the quality and performance of the Slovak and Czech health systems before and after 1989, including the year of separation in 1993, using the concept of 'avoidable' mortality. METHODS Age-standardized mortality rates for mortality from 'avoidable' and other (non-avoidable) causes have been calculated through indirect standardization to study national and regional trends between 1971 and 2008. RESULTS The paper shows that 'avoidable' mortality in both countries has been continuously decreasing while mortality from other causes has remained unchanged or increased slightly. For some 'avoidable' conditions, mortality rates of the two countries converge while for others divergence can be observed, with either the Czech Republic or Slovakia performing better. CONCLUSION Declines in overall 'avoidable' mortality suggest improvements in the health system's performance and quality of care in both countries, compared with mortality from other causes where factors outside the control of the health care system may be stronger determinants. For conditions where 'avoidable' mortality rates stagnate or increase, more in-depth research should be carried out to identify problems in the delivery of timely and effective prevention and treatment, and to establish steps that would reduce the numbers of unnecessary deaths.

Local Public Health System Performance and Community Health Outcomes

Public health systems are charged with protecting the health and well-being of the communities they serve. Higher-performing public health systems should be associated with improved community health status. Currently, little research examines the impact of variations in public health system performance on community health outcomes. The current study seeks to provide local public health system partners with evidence regarding the impact of their efforts. It does so through examining the relationship between variations in local public health system performance in providing the core functions of public health (assessment, assurance, and policy development) and community health outcomes. Measures of community health status (dependent variables) and community demographic characteristics, collected from 1994 to 2003, were merged with measures of public health system performance collected from 2002 to 2007 (independent variables). For each dependent variable, Pearson correlations were calculated with all of the independent variables. Multivariate linear regression models were developed for each health outcome. Analysis was completed in 2010. Bivariate analysis found nine associations between local public health system performance and health outcomes. Linear regression models found associations between performance and three of the six outcomes measured. The outcomes associated with performance are those that would seem to be most sensitive to variations in practice. Poverty is significantly associated with all the health outcomes measured. These associations between performance and health outcomes suggest that improving performance of the core functions of public health may improve health.

Assessing Preventable Hospitalisation InDicators (APHID): protocol for a data-linkage study using cohort study and administrative data

IntroductionPotentially preventable hospitalisation (PPH) has been adopted widely by international health systems as an indicator of the accessibility and overall effectiveness of primary care. The Assessing Preventable Hospitalisation InDicators (APHID)...

Variations in amenable mortality—Trends in 16 high-income nations

Background There has been growing interest in the comparison of health system performance within and between countries, using a range of different indicators. This study examines trends in amenable mortality, as one measure of health system performance, in sixteen high-income countries. Methods Amenable mortality was defined as premature death from causes that should not occur in the presence of timely and effective health care. We analysed age-standardised rates of amenable mortality under age 75 in 16 countries for 1997/1998 and 2006/2007. Results Amenable mortality remains an important contributor to premature mortality in 16 high-income countries, accounting for 24% of deaths under age 75. Between 1997/1998 and 2006/2007, amenable mortality fell by between 20.5% in the US and 42.1% in Ireland (average decline: 31%). In 2007, amenable mortality in the US was almost twice that in France, which had the lowest levels. Conclusions Amenable mortality continues to fall across high-income nations although the USA is lagging increasingly behind other high income countries. Despite its many limitations, amenable mortality remains a useful indicator to monitor progress of nations.

The patient satisfaction study in a multispecialty tertiary level hospital, PGIMER, Chandigarh, India

PurposeAgainst a background of growing consumerism, satisfying patients has become a key task for all healthcare activities. Satisfaction in service provision is increasingly being used as a measure of health system performance. Satisfaction manifests itself in the distribution, access and utilization of health services. This paper aims to address these issues.Design/methodology/approachA cross sectional study was conducted to assess the patient satisfaction level visiting the hospital with the objectives to know the behavior and clinical care by the clinicians and para‐medical staff and in terms of amenities available. A pre‐designed and pre‐tested structured questionnaire was given to the respondents after the patients had undergone consultation with the doctor. A proportionate random sampling was done to select the subjects.FindingsIt was found that average time spent by respondents for registration was 33.20 minutes. The overall satisfaction regarding the doctor‐patient professional and behavioral communication was more than 80 per cent at almost all the levels of health care facilities. In total, 55 per cent of respondents opined that doctors have shown little interest to listen to their problem while 2/3 opined that doctors used medical and technical terms to explain their illness and its consequences. More than 70 per cent satisfaction level was observed with staff of laboratories and security personnel with their cooperation and sympathetic nature. More than 80.0 per cent were satisfied with basic amenities. Of these, 40.0 per cent were of the view that services were costlier than their affordability.Originality/valueThis is the first ever study conducted to assess the patient satisfaction level in a premier multi‐specialty hospital of North India.

Making Health System Performance Measurement Useful to Policy Makers: Aligning Strategies, Measurement and Local Health System Accountability in Ontario

This study examined the experience of the Ontario Ministry of Health and Long-Term Care in enhancing its stewardship and performance management role by developing a health system strategy map and a strategy-based scorecard through a process of policy reviews and expert consultations, and linking them to accountability agreements. An evaluation of the implementation and of the effects of the policy intervention has been carried out through direct policy observation over three years, document analysis, interviews with decision-makers and systematic discussion of findings with other authors and external reviewers. Cascading strategies at health and local health system levels were identified, and a core set of health system and local health system performance indicators was selected and incorporated into accountability agreements with the Local Health Integration Networks. despite the persistence of such challenges as measurement limitations and lack of systematic linkage to decision-making processes, these activities helped to strengthen substantially the ministry's performance management function.

Study on patient satisfaction in the government allopathic health facilities of Lucknow district, India

Background:The outcome of any disease is influenced by the decisions to seek care, timely arrival at appropriate diagnostic and treatment services and the receipt of adequate care from service providers. Satisfaction in service provision is increasingly being used as a measure of health system performance. Satisfaction manifests itself in the distribution, access and utilization of health services. Objectives: To determine the areas and causes of low satisfaction among the patients and suggest methods for improvement.Materials and Methods:Multistage stratified random sampling was used to select the government allopathic health facilities of Lucknow district and systematic random sampling for the selection of the patients for the interview.Results:The accessibility was difficult in 42% patients and waiting time more than 30 min for 62.5% of those attending the tertiary level health facility. The satisfaction with the duration of the outpatient department (OPD) (64.6%) and the presence of signboards (46.6%) was also found to be low. The overall satisfaction regarding the doctor-patient communication was more than 60% at all the levels of health care facilities but that with the examination and consultation was less than 60% at the primary level as compared to more than 80% elsewhere. The most important motivating factor for the visit to the tertiary (48.2%) and secondary level (71.9%, 67.1%) of health facilities was the faith on doctors or health facility.Conclusions:The level of patient satisfaction is severely deficient in several areas and needs improvement for the achievement of optimal health of the people.

Making the Countdown count

The 2008 Countdown report comes at a particularly important time-the midpoint for achieving the Millennium Development Goals (MDGs) in 2015. This issue of The Lancet focuses on the 2008 results of the Countdown to 2015 for Maternal Newborn and Child Survival initiative and coincides with the Countdown meeting in Cape Town South Africa held jointly with the Inter-Parliamentary Union. Countdown a collaboration of individuals and institutions aims to stimulate country action by tracking coverage for interventions that are essential for the attainment of MDGs 4 and 5 as well as elements of the other health-related MDGs. In 2006 we reported on coverage of child survival interventions for 60 countries in the first international Countdown conference held in London in December 2005. The Countdown 2008 report tracks progress in 68 countries that account for more than 97% of maternal and child deaths and includes indicators across the continuum of care for reproductive maternal newborn and child health. The coverage results are complemented by tracking of relevant policies health system performance measures equity patterns in coverage and financial flows to maternal newborn and child health and nutrition. (excerpt)

States With More Health Care Spending Have Better-Quality Health Care: Lessons About Medicare

Based on broad measures of health system quality and performance, states with more total health spending per capita have better-quality care. This fact contrasts with a previous finding that states with higher Medicare spending per enrollee have poorer-quality care. However, quality results from the total funds available and not from Medicare or any single payer. Moreover, Medicare payments are disproportionately high in states that have a disproportionately large social burden and low health care spending overall. These and other vagaries of Medicare spending pose critical challenges to research that depends on Medicare spending to define regional variation in health care.

The New Architects Of Health Care Reform

Rising health care costs have been an issue for decades, yet federal-level health care reform hasn't happened. Support for reform, however, has changed. Purchasers fear that health care cost growth is becoming unaffordable. Research on costs and quality is questioning value. International comparisons rank the United States low on important health system performance measures. Yet it is not these factors but the unsustainable costs of Medicare and Medicaid that will narrow the window for health care stakeholders to shape policy. Unless the health care system is effectively reformed, sometime after the 2008 election, budget hawks and national security experts will eventually combine forces to cut health spending, ultimately determining health policy for the nation.

Datapoints: Treatment for New Episodes of Depression

Despite concerns regarding depression treatment in primary care settings (1), few studies have examined how receipt of recommended services may vary across settings where new episodes of depression are diagnosed. Veterans Affairs (VA) health system performance measures for new episodes of depression call for antidepressant coverage for at least 84 of the 114 days after the index prescription and at least three outpatient contacts for depression treatment during the 12week acute treatment phase. We examined VA depression treatment among all outpatients with new episodes of depression diagnosed in VA community-based outpatient clinics (CBOCs) or medical centers (VAMCs) during the first quarter of fiscal year 2003 (N=10,545). We assessed receipt of services overall and by clinic setting where depression was first diagnosed. A total of 6,963 patients (66%) were diagnosed in mental health clinics, and 3,582 (34%) were diagnosed in nonpsychiatric clinics. Overall, 66% of patients received sustained antidepressant coverage, 16% had adequate follow-up visits, and 12% received guideline-recommended services for both measures. For patients diagnosed in mental health clinics, 4,505 (65%) received sustained antidepressant coverage and 1,309 (19%) had adequate outpatient follow-up, whereas for those diagnosed in nonpsychiatric clinics, 2,406 (67%) received adequate antidepressant coverage and 359 (10%) had adequate follow-up. Patients diagnosed in outpatient mental health settings were 1.9 times more likely than those diagnosed in nonpsychiatric clinics to have received adequate follow-up (χ 2 =

Datapoints: Treatment for New Episodes of Depression

Despite concerns regarding depression treatment in primary care settings (1), few studies have examined how receipt of recommended services may vary across settings where new episodes of depression are diagnosed. Veterans Affairs (VA) health system performance measures for new episodes of depression call for antidepressant coverage for at least 84 of the 114 days after the index prescription and at least three outpatient contacts for depression treatment during the 12week acute treatment phase. We examined VA depression treatment among all outpatients with new episodes of depression diagnosed in VA community-based outpatient clinics (CBOCs) or medical centers (VAMCs) during the first quarter of fiscal year 2003 (N=10,545). We assessed receipt of services overall and by clinic setting where depression was first diagnosed. A total of 6,963 patients (66%) were diagnosed in mental health clinics, and 3,582 (34%) were diagnosed in nonpsychiatric clinics. Overall, 66% of patients received sustained antidepressant coverage, 16% had adequate follow-up visits, and 12% received guideline-recommended services for both measures. For patients diagnosed in mental health clinics, 4,505 (65%) received sustained antidepressant coverage and 1,309 (19%) had adequate outpatient follow-up, whereas for those diagnosed in nonpsychiatric clinics, 2,406 (67%) received adequate antidepressant coverage and 359 (10%) had adequate follow-up. Patients diagnosed in outpatient mental health settings were 1.9 times more likely than those diagnosed in nonpsychiatric clinics to have received adequate follow-up (χ 2 =

The autopsy as a performance measure and teaching tool

A survey of pathology training programs about current operations and attitudes revealed that the autopsy is underused in medical student and pathology resident teaching, is inadequately reported, often does not have a dedicated faculty, is not championed by pathologists or clinicians, is not valued as a performance measure, and is barely used as a resource for medical research. The autopsy can be reestablished as a teaching tool and performance measure, but this will require that the autopsy be recognized as a credible and valuable medical procedure. The autopsy must then be funded; and new sources of both volume and funding, such as incorporating autopsies into payment schedules, into clinical trials, and in pay-for-performance initiatives, must be solicited. Once there is reimbursement for autopsies, pathologists, clinicians, and health care administrators will embrace the autopsy as a new source of revenue and as a valid measure of physician, hospital, and health system performance. Pathologists and the pathology specialty societies must take the lead in the reestablishment of the autopsy and must, at the same time, encourage innovations such as centralization, greater use of Pathology Assistants, and application of molecular techniques. New tools for using the autopsy in medical student teaching should be embraced, and the role of the autopsy in pathology residency programs must be reevaluated.

Assessment of validity of the national public health performance standards: the local public health performance assessment instrument.

The National Public Health Performance Standards Program (NPHPSP) has developed performance standards measurement instruments, based on the 10 "Essential Services of Public Health" that are being tested in several states. This article is a report on the face and content validity of the instrument designed for local public health systems. Judgments about the face validity of the standards were obtained in a survey of local public health systems that had used the instrument in a test state. The validity of each standard was addressed along the following dimensions: the importance of the standard as a measure of the Essential Service; its completeness as a measure; and its reasonableness for achievement. All standards for each Essential Service were then judged in terms of their completeness in measuring performance of that service. Respondents judged the standards to be highly valid measures of local public health system performance. Some respondents had reservations about whether standards related to "enforcing laws and regulations" were achievable. Holding local public health systems accountable for the activities of other agencies was a factor mentioned in conjunction with those standards. The NPHPSP standards have face and content validity for measuring local public health system performance. Further testing of their validity and reliability is continuing.

Evaluation of an Occupational Health and Safety Management System Performance Measurement Tool—III: Measurement of Initiation Elements

Evaluation of an Occupational Health and Safety Management System Performance Measurement Tool—III: Measurement of Initiation Elements

Evaluation of an Occupational Health and Safety Management System Performance Measurement Tool—II: Scoring Methods and Field Study Sites

Evaluation of an Occupational Health and Safety Management System Performance Measurement Tool—II: Scoring Methods and Field Study Sites

Global health. WHO ranking of health system performance.

In its World Health Report 2000 (WHR2000), the World Health Organization published a ranking of its measures of health system performance of its 191 member states. WHO9s performance measurement initiative both stimulated and contributed to debate on an important and neglected topic. This policy forum argues, however, that the WHO algorithm has serious shortcomings in that it neglects potential variables (such as geography) that can affect a country9s performance.

A conceptual framework to measure performance of the public health system.

This article describes a unifying conceptual framework for the public health system as a way to facilitate the measurement of public health system performance. A conceptual framework for the public health system was developed on the basis of the work of Donabedian and a conceptual model previously developed by Bernard Turnock and Arden Handler. The conceptual framework consists of 5 components that can be considered in relationship to each other: macro context, mission, structural capacity, processes, and outcomes. Although the availability of measures for each of these components varies, the framework can be used to examine the performance of public health systems as well as that of agencies and programs. A conceptual framework that explicates the relationships among the various components of the public health system is an essential step toward providing a science base for the study of public health system performance.

Part 1: Historical and Theoretical Underpinnings

This set of six manuscripts describes the content and impact of the WAMI Rural Hospital Project (RHP), a research and development effort supported by the W.K. Kellogg Foundation, designed to improve the delivery of health services in six rural communities in the Pacific Northwest and Alaska. The major objective of the RHP--an activity which spanned a four-year period from 1985 through 1988--was to assist the project communities in improving the financial stability and quality of care of their local health care systems. Special attention was directed at helping the communities determine and implement an appropriate scope of health services, improve management and governance of the local health care enterprise, recruit and retain additional health personnel, and increase the extent to which community residents used local health services. In this first section we discuss the historical antecedents and conceptual underpinnings of the RHP and describe the five principal phases of the project. These include: (1) selection of communities for participation in the RHP, (2) comprehensive analysis of the health care system in each community, (3) community health services planning, including the development of comprehensive strategic plans, (4) implementation of techniques to improve local health services, and (5) project dissemination and evaluation. A pre-test, post-test model was employed to assess qualitative and quantitative changes in a variety of key measures of health system performance, including organization and management, scope of services, fiscal viability of the rural hospital, and utilization and patient satisfaction with health services in each community. The results of this evaluation constitute the balance of this report.