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At least 19 recordsLinked to original sources
PubMed2006

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

UNLABELLED: 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. METHODS: 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.

Benchmarking↗
PubMed2006

A conceptual framework for the OECD Health Care Quality Indicators Project.

ISSUES: The Health Care Quality Indicator (HCQI) Project of the Organization for Economic Cooperation and Development (OECD), which is aimed at developing a set of indicators for comparing the quality of health care across OECD member countries, requires a balanced conceptual framework that outlines the main concepts and domains of performance that should be captured for the current and subsequent phases of the project. ADDRESSING THE ISSUES: This article develops a conceptual framework for the OECD's HCQI Project. It first argues that developing such a framework should start by addressing the question, 'performance of what-and to what ends?' We identify at least two different major classes of frameworks: (i) health and (ii) health care performance frameworks, both of which are in common use. For the HCQI, we suggest a conceptual framework that is largely a purposeful modification of the existing performance frameworks and which is driven by the health determinants model. CONCLUSIONS: The conceptual basis for performance frameworks can be traced back to the health determinants model. A health performance framework takes a broader, societal or public health view of health determination, whereas a health care performance takes a narrower, mostly clinical or technical view of health care in relation to health (needs). This article proposes an HCQI framework that focuses on the quality of health care, maintains a broader perspective on health and its other determinants, and recognizes the key aims of health policy.

Benchmarking↗
PubMed2006

OECD Health Care Quality Indicator Project. The expert panel on primary care prevention and health promotion.

PURPOSE: This article describes a project undertaken as part of the Organization for Economic Co-operation and Development (OECD)'s Healthcare Quality Indicator (HCQI) Project, which aimed to develop a set of quality indicators representing the domains of primary care, prevention and health promotion, and which could be used to assess the performance of primary care systems. METHODS: Existing quality indicators from around the world were mapped to an organizing framework which related primary care, prevention, and health promotion. The indicators were judged against the US Institute of Medicine's assessment criteria of importance and scientific soundness, and only those which met these criteria and were likely to be feasible were included. An initial large set of indicators was reduced by the primary care expert panel using a modified Delphi process. RESULTS: A set of 27 indicators was produced. Six of them were related to health promotion, covering health-related behaviours that are typically targeted by health education and outreach campaigns, 13 to preventive care with a focus on prenatal care and immunizations and eight to primary clinical care mainly addressing activities related to risk reduction. The indicators selected placed a strong emphasis on the public health aspects of primary care. CONCLUSIONS: This project represents an important but preliminary step towards a set of measures to evaluate and compare primary care quality. Further work is required to assess the operational feasibility of the indicators and the validity of any benchmarking data drawn from international comparisons. A conceptual framework needs to be developed that comprehensively captures the complex construct of primary care as a basis for the selection of additional indicators.

Benchmarking↗
PubMed2003

Can health care quality indicators be transferred between countries?

OBJECTIVE: To evaluate the transferability of primary care quality indicators by comparing indicators for common clinical problems developed using the same method in the UK and the USA. METHOD: Quality indicators developed in the USA for a range of common conditions using the RAND-UCLA appropriateness method were applied to 19 common primary care conditions in the UK. The US indicators for the selected conditions were used as a starting point, but the literature reviews were updated and panels of UK primary care practitioners were convened to develop quality indicators applicable to British general practice. RESULTS: Of 174 indicators covering 18 conditions in the US set for which a direct comparison could be made, 98 (56.3%) had indicators in the UK set which were exactly or nearly equivalent. Some of the differences may have related to differences in the process of developing the indicators, but many appeared to relate to differences in clinical practice or norms of professional behaviour in the two countries. There was a small but non-significant relationship between the strength of evidence for an indicator and the probability of it appearing in both sets of indicators. CONCLUSION: There are considerable benefits in using work from other settings in developing measures of quality of care. However, indicators cannot simply be transferred directly between countries without an intermediate process to allow for variation in professional culture or clinical practice.

Cross-Cultural Comparison↗
PubMed2006

Development and implementation of a nationwide health care quality indicator system in Taiwan.

UNLABELLED: QUALITY ISSUES: Quality is an increasingly important issue to the health care sector. The Taiwanese government also recognizes the need to implement a nationwide health care quality indicator system to strengthen quality surveillance. CHOICE OF SOLUTION: In 1999, the Department of Health funded a 2-year project led by the Taiwan Healthcare Executive College to develop a comprehensive performance assessment system, subsequently named as Taiwan Healthcare Indicator Series (THIS). The series includes four categories of indicators, namely outpatient, in-patient, emergency care, and intensive care, and has 139 items in total. IMPLEMENTATION: The system was officially launched in 2001. Participation is voluntary. The Taiwan Healthcare Executive College processes the data and provides feedback to the participating hospitals. The information is for the participating hospitals' own use and is not released to the public. EVALUATION: Participating hospitals have increased from 45 in 2001 to 227 in 2006 and now constitute approximately 50% of the total hospital population in Taiwan. The reporting rate averaged 77.7% in 2004. The first five most reported indicators are the percentage of first-visit outpatients to outpatient clinics, the average length of in-patient stay, the nosocomial infection rate, the occupancy rate, and the crude mortality rate. LESSONS LEARNED: How the data are interpreted and how data interpretation can lead to quality improvement are the principal concerns of participating hospitals. In light of the success of the indicator series, the Bureau of National Health Insurance (BNHI) of Taiwan has proposed participation in the series as being one of the criteria to be reimbursed for quality.

Hospitals↗
PubMed2006

The OECD Health Care Quality Indicators Project: history and background.

OBJECTIVE: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.

Benchmarking↗
PubMedDate not supplied

[Use of health care quality indicators in the study of the therapeutic-diagnostic process].

Definition of the notions "medical care quality" (MCQ) and "medical error" (ME) and their range depending on the negative effect of ME on the status of essential signs of MCQ, obligatory registration and possibility of universal description of all detected ME and their negative consequences by means of automated expert methods helped the authors develop quantitative parameters of the state of 3 components of MCQ. Based on these data, integral value of MCQ state and the structure of facultative MCQ were estimated.

Delivery of Health Care↗
PubMed2004

[Development of an indicator system for evaluating the quality of health care services].

Indicator system development for evaluating the quality of health services. The National Health Insurance Fund of Hungary introduces indicators for evaluating the quality of health services. The new system starts by the end of 2003 on the Internet and it will be updated and improved on a regular base. The quality indicators provide possibility to compare the health services and follow up the changes. The Hungarian indicators came from those indicators, which are described, tested and used in the international literature and practice. The data derive from the routinely collected financial data of the National Health Insurance Fund. The conclusions drawn form the results will be arranged and interpreted according to the types of indicators. Those providers whose have out of the ordinary values should fill in a standardized questionnaire--which was developed with the representatives of the certain profession--for explaining the results and define quality improvement plan. The aim of the programme is to increase transparency of health services, to enhance quality improvement and to support the certification and accreditation programmes.

Health Care Surveys↗
PubMed2005

Using the AHRQ quality indicators to improve health care quality.

In summary, the AHRQ QIs are a set of readily available programs that can be downloaded without charge from the AHRQ Web site. The methodology is completely open and accessible to all users. The QI software can be applied to hospital administrative data that is available within individual institutions or from state data organizations and hospital associations and can provide valuable insights into health care quality at extremely low cost. The QIs have been incorporated into numerous quality assessment reports, including hospital-specific reports, with the aim of improving health care quality at a reasonable cost. With enhancements currently underway, the QIs will be an even more valuable part of the toolkit to improve health care quality in the United States.

Quality Assurance, Health Care↗
PubMed2002

[Comprehensive quality indicators for health care services].

On behalf of the Swedish government, the National Board of Health and Welfare recently issued a recommended set of 60 quality indicators for broad monitoring of the quality of national health care. This initiative is in concordance with similar international initiatives. The Swedish process, however, is unique in the sense that the professions have developed the indicator and more than 40 national quality registers already monitor most of them. Health care professionals in Sweden have a long-standing tradition of measuring and monitoring results including comparing the quality of different health providers by means of the quality registers. However, the transparency by which these measures are presented, the general understanding of how such data should be interpreted and used in practice is as yet not sufficiently developed. Transparency of data combined with knowledgeable interpretation by health professionals will provide patients with sound information about health care quality and the necessary prerequisites for making comparisons between providers. It will also help guiding managers and politicians making decisions. In order to reach this objective, close co-operation between patient organisations, health care managers and the professionals is needed including a common understanding of the needs and perspectives of all parties.

Decision Making↗
PubMed2006

Selecting indicators for the quality of cardiac care at the health system level in Organization for Economic Co-operation and Development countries.

BACKGROUND: Cardiovascular (CV) diseases are major causes of morbidity and death in adults in the world. Major differences have been reported in the management strategies and the outcome of CV diseases within and between countries. To better understand and address these differences, there is a need for quantitative information on patient management, outcome, and prognosis. OBJECTIVE: This article describes the development of a set of quality indicators for cardiac care and summarizes work undertaken by the Cardiac Care Panel of the OECD Health Care Quality Indicators Project. METHODS: A list of 61 potential indicators was identified through a literature search, review of national measurement systems, and nomination from countries participating in the project. The Cardiac Care Panel then used a modified Delphi process developed originally by RAND to select indicators. Panel members individually rated each indicator on a scale of 1-9 for scientific soundness and importance. All indicators receiving scores of 7 or more for both importance and soundness were included in the final set. RESULTS: Seventeen cardiac indicators were selected for the final set of indicators from the following areas: acute coronary syndromes, cardiac interventions, secondary prevention, and congestive heart failure. CONCLUSIONS: The final set of 17 indicators selected by the Cardiac Care Panel constitutes a comprehensive set of measures for the most relevant domains of CV care. Nevertheless, gaps remain in the area of primary prevention and in particular in areas with rapidly changing technology and improving treatment options.

Benchmarking↗
PubMed2003

Quality indicators for primary care mental health services.

OBJECTIVES: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement. DESIGN: Modified two-round postal Delphi questionnaire. SETTING: Geographical spread across Great Britain. PARTICIPANTS: One hundred and fifteen panellists representing 11 different stakeholder groups within primary care mental health services (clinical psychologist, health and social care commissioner, community psychiatric nurse, counsellor, general practitioner, practice nurse/district nurse/health visitor, psychiatrist, social worker, carer, patient and voluntary organisations). MAIN OUTCOME MEASURES: Face validity (median rating of 8 or 9 on a nine point scale with agreement by all panels) for assessing quality of care. RESULTS: A maximum of 334 indicators were rated by panels in the second round; 26% were rated valid by all panels. These indicators were categorised into 21 aspects of care, 11 relating to general practices and 10 relating to health authorities or primary care groups/trusts. There was variation in the total number of indicators rated valid across the different panels. Overall, GPs rated the lowest number of indicators as valid (41%, n=138) and carers rated the highest number valid (91%, n=304). CONCLUSIONS: The quality indicators represent consensus among key stakeholder groups in defining quality of care within primary care mental health services. These indicators could provide a guide for primary care organisations embarking on quality improvement initiatives in mental health care when addressing national targets and standards relating to primary care set out in the National Service Framework for Mental Health for England. Although many of the indicators relate to parochial issues in UK service delivery, the methodology used in the development of the indicators could be applied in other settings to produce locally relevant indicators.

Attitude of Health Personnel↗
PubMedDate not supplied

Perceptions of quality health care among parents of children with bleeding disorders.

INTRODUCTION: This study examined how parents of children with bleeding disorders defined quality health care, their expectations for care at the clinic, and indicators of quality health care important to them. METHODS: Parents (N = 54) answered two open-ended questions and completed the Quality Health Care Questionnaire, which examined the importance of 33 indicators of quality care. RESULTS: The most important indicators of quality care to parents were being included in decisions about their child's care (M = 4.98), being cared for by nurses who are competent and up-to-date (M = 4.94), and being cared for by doctors who are competent and up-to-date (M = 4.94). DISCUSSION: The results of this study are consistent with earlier research involving other groups of consumers. Parents view quality care as being included in decisions about their child's care and having competent and caring providers with whom they can communicate. In contrast to earlier research, however, waiting time was the least important indicator of quality care.

Blood Coagulation Disorders↗
PubMed1999

Measuring the outcome of paediatric intensive care.

This paper describes the background to the publication of the paediatric intensive care framework (NHS Executive 1997a) and sets out the case for outcome assessment of paediatric intensive care. Issues relating to mortality and morbidity assessment are discussed and several assessment tools are outlined. It is proposed that functional and psychological outcome assessments are important indicators of the quality of health care provision.

Child Development↗
PubMedDate not supplied

Mental health and satisfaction with primary health care in female patients.

PURPOSE AND OBJECTIVES: Patient satisfaction is an important outcome in patient care and is increasingly being used as an indicator of quality of care within large health systems. This study examined whether consideration of specific mental health factors, including posttraumatic stress disorder (PTSD), can improve our understanding of patient satisfaction in primary care settings. METHODS: Questionnaires were mailed to all women who used the VA San Diego Healthcare System primary care clinic in 1998. Two hundred twenty-one (56%) women who were invited to participate in this study completed questionnaires. Participants provided information about physical and mental health and satisfaction with their primary medical care. RESULTS: Age and general mental health were negatively associated and PTSD was positively associated with overall satisfaction with care and satisfaction with the provider. General mental health was significantly related to satisfaction with the clinic. CONCLUSIONS: These findings support the importance of specific mental health symptoms, and trauma-related symptoms in specific, in determining satisfaction.

Adult↗
PubMed2002

Understanding the causal relationship between patient-reported interpersonal and technical quality of care for depression.

OBJECTIVES: Patient ratings of their health care experience have become increasingly important as indicators of interpersonal quality of care. Currently the link between technical and interpersonal quality of care indicators is not well understood. The goal of this study was to examine the temporal relationship between technical quality of care for depression and interpersonal quality of care by examining their association over time. METHODS: A cross-lagged (longitudinal) path analytic model was estimated to examine the causal relationship between two measures of interpersonal quality of care and technical quality of care among 697 respondents participating in the 18 and 24 month assessments of Partners in Care (PIC). Measures of age, gender, number of chronic diseases, indicators of anxiety and depression, recent service utilization, and stability of the doctor-patient relationship were included as covariates. RESULTS: After controlling for study design and relevant patient characteristics, one significant cross-lagged effect was found: that from one measure of interpersonal quality (patient satisfaction) to technical quality (standardized coefficient = 0.18), but not from quality to satisfaction. CONCLUSION: Results of these analyses indicate that patients who report high satisfaction with care are more likely to receive higher technical quality depression care 6 months later as compared with those who are less satisfied. This implies that one pathway to improving technical quality of care may be through increasing patients' satisfaction.

Adult↗
PubMed2001

Process versus outcome indicators in the assessment of quality of health care.

This paper reviews the relative strengths and weaknesses of outcome and process measures as performance indicators in health care. Differences in outcome may be due to case mix, how the data were collected, chance, or quality of care. Health care is only one determinant of health and other factors have important effects on health outcomes, such as nutrition, environment, lifestyle and poverty. The advantages of process measures are that they are more sensitive to differences in the quality of care and they are direct measures of quality. However, outcome measures are of greater intrinsic interest and can reflect all aspects of care, including those that are otherwise difficult to measure such as technical expertise and operator skill. Outcome indicators can be improved if efforts are made to standardize data collection and case mix adjustment systems are developed and validated. It is argued that this is worth doing only where it is likely that variations in health care might lead to significant variations in health outcome and where the occurrence of the outcome is sufficiently common that the outcome indicator will have the power to detect real differences in quality. If these conditions are not met, then alternative strategies such as process measurement and risk management techniques may be more effective at protecting the public from poor quality care.

Clinical Competence↗