PERFORMANCE REPORTING IN OECDCOUNTRIESNiek Klazinga, HARC, Sydney December 2 2014

niek.klazinga@oecd.org

3

Most recent Health Statistics OECD

Slow recovery in health spending in many countries after a period of

decline

Life expectancy at birth, 1970 and 2011 (or nearest year) Source: OECD

Health Statistics 2013, http://dx.doi.org/10.1787/health-data-en; World Bank for

non-OECD countries

• Quality of health care services is seen in the overall context of health system performance, population health and health system development.

• The performance of the health care system is one of the determinants of population health alongside non-medical determinants of health such as behavioural and environmental factors

• In OECD reports quality has 3 components; effectiveness, safety and person centeredness

• It is used alongside the domains access and costs/expenditure and the cross cutting domains efficiency and equity

Conceptual notions

This conceptual thinking is reflected in the framework used for

reporting statistics in OECD’s Health at a Glance

• The OECD Health Data Questionnaire collects data on a range of variables related to health status, non-medical determinants of health, the pharmaceutical market, waiting times, long-term care resources and utilisation, and public and private health insurance coverage.

• The OECD/Eurostat/WHO-Europe Joint Questionnaire on Non-Monetary Health Care Statistics collects data on health care resources (human and technical) and health care activities.

• The OECD/Eurostat/WHO Joint Health Accounts Questionnaire collects data on health expenditure by function, provider and financing scheme, based on the System of Health Accounts.

• The OECD/Eurostat Purchasing Power Parity (PPP) Questionnaire collects data on the prices of a selected set of health services and goods (for the purpose of developing health-specific and economy-wide PPP indices).

• The OECD Health Care Quality Indicators Questionnaire collects data on quality of care (including health outcomes and patient safety).

OECD Statistics

3Overarching indicators

Helping people to recover from episodes of ill health or

following injury

3a Emergency admissions for acute conditions that should not usually require

hospital admission

3b i Emergency readmissions within 30 days of discharge from hospital

(PHOF 4.11*)

Improving outcomes from planned treatments

3.1 Total health gain as assessed by patients for elective procedures

i Physical Health-related procedures

ii Mental Health-related procedures

iii Recovery in Quality of life for patients with mental health problems

Preventing lower respiratory tract infections (LRTI) in children from

becoming serious

3.2 Emergency admissions for children with LRTI

Improving recovery from injuries and trauma

3.3 Survival from major trauma

Improving recovery from stroke

3.4 Proportion of stroke patients reporting an improvement in activity/lifestyle

on the Modified Rankin Scale at 6 months

Improving recovery from fragility fractures (Wording amended)

3.5 Proportion of patients with hip fractures recovering to their previous levels

of mobility/walking ability at i 30 and ii 120 days

Helping older people to recover their independence after illness or injury

3.6 i Proportion of older people (65 and over) who were still at home 91 days

after discharge from hospital into reablement / rehabilitation service

(ASCOF 2B[1]*)

ii Proportion offered rehabilitation following discharge from acute or

community hospital (ASCOF 2B[2]*)

Enhancing quality of life for people with long-term

conditions2Overarching indicators

2 Health-related quality of life for people with long-term conditions (ASCOF

1A**)Improvement

areasEnsuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

Improving functional ability in people with long-term conditions

2.2 Employment of people with long-term conditions (ASCOF 1E** , PHOF

1.8*)Reducing time spent in hospital by people with long-term conditions

2.3 i Unplanned hospitalisation for chronic ambulatory care sensitive

conditions

ii Unplanned hospitalisation for asthma, diabetes and epilepsy in under

19s

iii Alcohol-related hospital admissions (PHOF 2.18*)

Enhancing quality of life for carers

2.4 Health-related quality of life for carers (ASCOF 1D**)

Enhancing quality of life for people with mental illness

2.5 i Employment of people with mental illness (ASCOF 1F** & PHOF 1.8**)

ii Health related quality of life for people with mental health problems

Preventing people from dying prematurely1Overarching indicators

1a Potential Years of Life Lost (PYLL) from causes considered amenable to

healthcare

i Adults ii Children and young people

1b Life expectancy at 75

i Males ii Females

1c Neonatal mortality and stillbirths

Improvement areas

Reducing premature death in people with mental illness

1.5 i Excess under 75 mortality rate in adults with serious mental illness

(PHOF 4.9*)

ii Excess under 75 mortality rate in adults with common mental illness

iii Mortality from suicide and injury of undetermined intent

(PHOF indicator 4.10**)

Reducing deaths in babies and young children

1.6 i Infant mortality (PHOF 4.1* )

ii (previously 1.6.iii) Five year survival from all cancers in children

Reducing premature mortality from the major causes of death

1.1 Under 75 mortality rate from cardiovascular disease (PHOF 4.4*)

1.2 Under 75 mortality rate from respiratory disease (PHOF 4.7*)

1.3 Under 75 mortality rate from liver disease (PHOF 4.6*)

1.4 Under 75 mortality rate from cancer (PHOF 4.5*)

i One- and ii Five-year survival from all cancers

iii One- and iv Five-year survival from breast, lung and colorectal cancer

v One- and vi Five-year survival at stage 1&2

Reducing premature death in people with a learning disability

1.7 Excess under 60 mortality rate in adults with a learning disability

4Overarching indicators

Ensuring that people have a positive experience of care

4a Patient experience of primary care

i GP services

ii GP Out-of-hours services

iii NHS dental services

4b Patient experience of hospital care

4c Friends and family test

4d Patient experience characterised as poor or worse

Improvement areas

Improving people’s experience of outpatient care

4.1 Patient experience of outpatient services

Improving hospitals’ responsiveness to personal needs

4.2 Responsiveness to in-patients’ personal needs

Improving access to primary care services

4.4 Access to i GP services and ii NHS dental services

Improving women and their families’ experience of maternity services

4.5 Women’s experience of maternity services

Improving the experience of care for people at the end of their lives

4.6 Bereaved carers’ views on the quality of care in the last 3 months of life

Improving experience of healthcare for people with mental illness

4.7 Patient experience of community mental health services

Improving children and young people’s experience of healthcare

4.8 Children and young people’s experience of outpatient services

Improving people’s experience of accident and emergency services

4.3 Patient experience of A&E services

Improving people’s experience of integrated care

4.9 People’s experience of integrated care (ASCOF 3E**)

Reducing the incidence of avoidable harm

5.1 Deaths from venous thromboembolism (VTE) related events

5.2 Incidence of healthcare associated infection (HCAI)

i MRSA

ii C. difficile

5.3 Proportion of patients with category 2, 3 and 4 pressure ulcers

5.4 Hip fractures from falls during hospital care

Improving the safety of maternity services

5.5 Admission of full-term babies to neonatal care (Definition amended)

Treating and caring for people in a safe environment

and protecting them from avoidable harm5Overarching indicators

5a (previously 5c) Deaths attributable to problems in healthcare

5b Severe harm attributable to problems in healthcare

Improvement areas

NHS Outcomes

Framework 2015/16at a glance – DRAFT

Alignment with Adult Social Care Outcomes Framework

(ASCOF) and/or Public Health Outcomes Framework (PHOF)

* Indicator is shared

** Indicator is complementary

Indicators in italics are placeholders, pending development or

identification

Enhancing quality of life for people with dementia

2.6 i Estimated diagnosis rate for people with dementia (PHOF 4.16*)

ii A measure of the effectiveness of post-diagnosis care in sustaining

independence and improving quality of life (ASCOF 2F**)

Dental Health

2.8 i Decaying teeth

ii Under 10 tooth extractions in secondary care

Improvement Areas

Improving the culture of safety reporting

5.6 Patient safety incidents reported

Conceptual Framework Dutch Report on health

System performance

Zorgbalans 2014 | 10 september 2014

10

• The 3 domains of quality (effectiveness, safety and person centeredness) are explored along 4 health care system functions; staying healthy, getting better, living with illness or disability and coping with the end of life (IoM)

• The HCQI program started in 2002, the framework was developed in 2004 and updated in 2013

• Quality Indicators have been reported on OECD countries since 2005 (at present 55 indicators and participation of 35 countries)

Conceptual notions in the Health Care

Quality Indicator program

Matrix Dimensions: Quality

Effectiveness

• Achieving desirable outcomes, given the correct provision of evidence-based health care services to all who could benefit

Safety

• System has the right structures, renders services and attains results in ways that prevent harm to the user, provider, or environment

Responsiveness/

Patient centeredness

• System actually functions by placing the patient/user at the center of its delivery of health care

• Infectious Diseases: vaccination rates children and flu-vaccination elderly

• Acute Care: 30-day case fatality rates AMI and Stroke

• Primary Care: hospital admission rates for chronic conditions (diabetes, asthma/COPD, Chronic Heart Failure) and prescribing rates antibiotics

• Cancer Care: screening, mortality and 5-year survival rates

• Mental Health: Excess Mortality persons with Severe Mental Health problems

• Patient Safety Indicators (PSI’s)

• Patient Experiences (respect, autonomy, communication)

Types of Health Care Quality Indicators

An evolving view of outcomes

Rationale, examples of measures and data sources

From Deaths

• Mortality and life-expectancy: classical parameters to measure health systems outcomes

• Look at outcome from a public health perspective• Need good death registries as an information source

To Diseases

• Prevalence and incidence of diseases are classical parameters to assess morbidity of diseases in a country

• Related outcome measures try to capture the reduction in morbidity and the outcomes of specific diseases (e.g. QALYs, SF36)

• Medical/clinical perspective is the dominant way of operationalizing outcome measures. Outcome measurement is dependent on clinical registries (such as on cancer and diabetes).

• Linking to costs (value) at system level (burden of diseases studies) and for specific services and interventions (cost-effectiveness studies)

To Disability

• Many chronic diseases come with long term disabilities and outcomes should also address the way a health system deals with disabilities

• At system level DALY (Disability Adjusted Life Expectancy) most well-known measure; at health services level various instruments available to assess disabilities and their outcomes (e.g. inter RAI initiative)

• Administrative data-bases and surveys are the main data source

To Discomfort

• Increasingly outcomes experienced by citizens/patients seen as an important outcome

• PROMS (patient reported outcomes) mainly tested for clinical procedures and treatments and still under development for chronic conditions ; EQ5D a more generic measure used.

• PREMs with some limited international validation of instruments (CAHPS, Picker)

• Death registries

• Clinical Registries (cancer, diabetes)

• Administrative Data-Bases

• (Electronic) Health Records

• Surveys

• Key factor is the capacity for data-linkage

Data Sources for OECD’s HCQI

Hospital

in-patient

data

Primary

care data

Cancer

registry

data

Prescription

medicines data

Mortality

data

Formal

long-term

care data

Patient

experiences

survey data

Mental

hospital

in-patient

data

Population

health survey

data

Population

census or

registry data

Australia No No No No Yes No No No No No

Belgium Yes Yes Yes Yes Yes nr Nr No No nr

Canada Yes na nr na nr nr Na Nr nr nr

Denmark Yes Yes Yes Yes Yes na No Yes No Yes

France nr No No No No nr No Nr No No

Finland Yes na Yes Yes Yes Yes No Yes No Yes

Germany No No No No No No Na Na No No

Israel Yes No Yes No Yes Yes No Yes No Yes

Japan No No na No nr nr Nr Nr nr nr

Korea Yes Yes Yes Yes Yes Yes No Yes No No

Malta Yes No Yes na Yes No Na No No No

Norway Yes No Yes No Yes No No No Yes Yes

Poland No No No No No No No No No No

Portugal No Yes nr Yes nr nr Nr No nr nr

Singapore Yes na Yes No Yes Yes No No Yes No

Sweden Yes na Yes Yes Yes na No Yes Yes nr

Switzerland No na na na No No Na No No No

United Kingdom Yes No Yes No Yes No No No No No

United States Yes No Yes Yes Yes No Yes No Yes Yes

Total Yes 12 4 11 7 12 4 1 5 4 4

National record linkage projects are used for regular health care quality

monitoring Source: OECD HCQI Questionnaire, Secondary Use of Health

Data, 2011/12

Asthma admissions

Antibiotics use

20

6.4

3.4

2.3

9.1

4.3

2.7

6.3

3.9

2.7

6.5

3.8

2.8

7

4.1

3.3

5.9

5.3

3.4

5.5

4.3

3.4

8.4

5.6

3.8

10.1

6.3

3.8

7.2

4.7

3.9

5.9

4.7

3.9

10.6

6.8

4.2

7.8

4

4.4

9.2

6.4

4.5

10.2

7

4.7

10.5

8.3

5.2

9.5

6.7

5.4

11.6

9.9

8.4

10.4

9.7

9.3

05

10

15

Rate

s p

er

100

adm

issio

ns

DNK

NO

RSW

ENZL

AUS

CAN

ITA

FIN IRL

ISR

USA

CZE

LUX

NLD

AUT

PRT

ESP

BEL

SG

P

2000, 2005 and 2011 (or nearest year)

AMI Case-Fatality (admission-based)

2000 2005 2011

Excess mortality from schizophrenia, 2006 and

2011 (or nearest year)

3.6 3.5

5.8

8.5

5.0

6.3

7.9

3.63.8

4.1

5.6

5.9 6.0

6.8

8.8

0

1

2

3

4

5

6

7

8

9

10

Korea Slovenia Denmark OECD (7) New Zealand Finland Israel Sweden

Ratio 2006 2011

Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en.

Postoperative pulmonary embolism or deep vein

thrombosis in adults, 2011 (or nearest year)

356

136

268

278

589

668

90

416

452

301

246

541

888

367

354

554

1294

454

n.a.

802

1759

107

264

307

315

409

421

426

432

500

557

591

603

664

701

768

783

795

812

865

1144

1207

0 500 1000 1500 2000

Belgium

Portugal

Spain

Poland ¹

Israel

Germany

Denmark

Italy ¹

Switzerland

United States

Finland ¹

OECD (20)

Canada

Norway

Sweden

Ireland

New Zealand

United Kingdom

France

Slovenia

Australia

Rates per 100 000 hospital discharges

Hip and knee replacement All surgeries

Source: OECD Health Statistics 2013 , http://dx.doi.org/10.1787/health-data-en.

R&D in OECD’s HCQI program 2014

• Enhancing international comparability of indicators on potential preventable hospital admissions (UK)

• Working towards a compound indicator on potential preventable hospital admissions (Canada)

• Indicators on amputation rates in patients with diabetes (Italy)

• Indicators on operation within 48h for patients with a hip fracture (Netherlands/Germany)

• Excess Mortality in Mental Health (UK)

• Indicators on Suicide (Denmark)

• Patient Safety Indicators (France)

• Indicators based on prescription data (OECD)

• Indicators on patient experiences (OECD)

OECD Agenda for Health Care Quality Indicators 2015/16

• Focus on the use of OECD’s HCQI’s in national and regional health system performance reports

• R&D work on Hospital Performance:

• Comparison of frameworks

• Inventory of Indicators used

• Overview of ways of public reporting

• Analyses of types of use of hospital performance indicators

• Describing spread of hospital performance within countries

• Building on Hospital performance work in previous European research projects (ECHO, EuroHope, BIRO ….)

• Continue working on strengthening the information infrastructure in OECD countries

Hospitals quality performance in care of AMI

patients on empirical Bayes estimates of random

coefficients

Stockholm 8.04.2014 EUROHOPE project

Reporting on Hospital Performance:

Canada

Success: effective use of information

(without financial incentives) in Israel

Asthma

Care

•Control medication

•Influenza vaccination

Cancer screening

Breast cancer

Colon cancer

Immunisationsfor older adults

Influenza vaccination

Pneumococcal vaccination

Child and adolescent

health

Anemia screening (infants)

BMI assessment

(adolescents)

Cardiovascular health

Primary prevention

•Cholesterol assessment

•Weight assessment

•Blood pressure assessment

Care

•Use of LDL modifiers

•Use of ACEI/ARB

•Use of beta blockers

Effectiveness of care

•Cholesterol assessment for cardiac patients

Diabetes

Care

•Glycemic control

•Cholesterol assessment

•Eye care

•Kidney care

•Immunisations

•Blood pressure assessment

•Weight assessment

Effectiveness of care

•Glycemic control

•Cholesterol management

•Blood pressure management

Israel Quality Indicators in Community Healthcare

niek.klazinga@oecd.org