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Health Care Quality Indicators Bridging Health Volume Output and Health Care Outcomes Niek Klazinga, UvA/OECD The concept of quality in health care OECD’s HCQI – Project Linking quality indicators with volume outputs and cost-accounting The concept of quality in Health Care

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Health Care Quality Indicators

  • Bridging Health Volume Output and Health Care Outcomes

  • Niek Klazinga, UvA/OECD


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The concept of quality in Health Care

  • Structure, process, outcome

  • Quality Domains: effectiveness, responsiveness ….

  • Quality of services versus quality of systems

  • Health care helps individuals and populations to realize their potential health

  • Quality relates to compliance of practices with evidence

  • Quality relates to health outcomes attributed to services


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Broad Purpose of OECD’s HCQI Project

  • Develop indicator set - to raise questions about quality of health care across countries

  • Initial attention - technical quality of health care (i.e. effectiveness)

  • Future consideration of other areas (e.g. “Responsiveness/patient centeredness”)

  • To be representative of the main disease and risk groups in participating countries


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HCQI Foundation

Analysis of available measures and consensus efforts

1. Application of scientific criteria for indicators

  • Scientific soundness

  • Clinical and policy importance

  • Feasibility of measurement

    2. Review balance of measure set

  • Structure, process and outcomes

HCQI Initial Measure Set

The Nordic Council of Ministers


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Streams of work of OECD’s HCQI Project

  • Regular data collection

    • Periodic Update of the set of indicators fit for international comparisons

    • Ongoing methodological work to improve indicators until fit for international comparisons

  • New indicator development in 5 priority areas establishing specific country expert subgroups.


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Figure 5. Conceptual framework

for Organization for Economic

Cooperation and Development

Health Care Quality Indicator

(HCQI) Project. The shaded

area represents the current

Focus of the HCQI Project.

Source: Arah OA, et al. A conceptural framework

for the OECD Health Care Quality Indicators

Project. Int J Quality Health Care. 2006; Sep 18;

Suppl.1:5-13.





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HCQI Progress (1): Publications

  • OECD Health Working Paper 22 – HCQI Initial Indicators Report (2006)

  • OECD Health Working Paper 23 – HCQI Conceptual Framework Paper (2006)

  • International Journal for Quality in Health Care HCQI supplement, September 2006


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HCQI Progress (4): New Indicator Development

  • Focus initially on patient safety and mental health

  • Patient Safety

    • Dublin seminar - “Safety Data for Safer Care” - First Meeting of the OECD HCQI Patient Safety Expert Group

    • Co-hosted with Irish Department of Health and Children

    • Two work initiatives developed and circulated

  • Mental health

    • Spring 2006 teleconference

    • Data questionnaire development Fall 2006

    • First Subgroup in-person meeting October 17-18, Paris


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Plans for 2007

  • HCQI Special Chapter in Health at a Glance2007

  • New indicator development:

    • Patient safetyinitiatives in hospital administrative data and adverse events systems; production of 2 working papers -June 2007

    • Mental health

      • Information collection and framework working paper on data and data systems; initial working paper April 2007

      • New indicator working paper – November 2007

    • Primary care and prevention

      Indicator subgroup launch – 2007


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Linking quality indicators with volume outputs and cost accounting

  • On system level only sensible when a long term prevention and disease perspective is taken linking the clinical logics model (McGlynn 2004) with cost of illness studies

  • On services level mainly sensible when using ICD9/10 data; limited meaningful links with DRG-data


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Bridging Health Volume Output and Health Care Outcomes accounting

  • Using HCQI’s for volume output measurement

  • Linking HCQI’s with functional prevention and disease pathways identified in national accounts


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