Health Care Quality Indicators Project

Health Care Quality Indicators Project
BackgroundInitial findings on health care qualityThe OECD health care quality frameworkMoving forward: improving quality data systemsOECD work in patient safetyOECD work in mental health care
OECD work in responsiveness and patient experiences
Project contacts
The HCQI Project will eventually represent the largest effort, in terms of number of quality indicators and number of countries, to assess international health care quality that has ever been undertaken.

Background
Started in 2001, the objective of the OECD Health Care Quality Indicator (HCQI) Project is to track health care quality. How? By developing a set of indicators that are:
Based on comparable data.
Can be used to raise questions for further investigation on quality differences across countries.The HCQI project has built on two pre-existing international collaborations organised by the Commonwealth Fund of New York and the Nordic Minister Council Working Group on Quality Measurement.
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Initial findings on health care quality
The Health Care Quality Indicators Project Initial Indicators Report, released in January 2006, discusses the many methodological issues and solutions in comparing health care quality across countries.
Key results showed that the indicators suitable for use in an initial HCQI indicator set are:
Breast cancer survival
Mammography screening
Cervical cancer survival
Cervical cancer screening
Colorectal cancer survival
Incidence of vaccine preventable diseases
Coverage for basic vaccination
Asthma mortality rate
AMI 30-day case fatality rate
Stroke 30-day case fatality rate
Waiting time for femur fracture surgery
Influenza vaccination for adults over 65
Smoking rates
The OECD health care quality framework
The quality framework laid out in the Health Care Quality Indicators Project Conceptual Framework Paper (also released in January 2006) represents an exhaustive review and synthesis of the major health system frameworks in use in both OECD countries and international organisations such as the World Health Organization.
It focuses the present work of the HCQI Project on the areas of effectiveness, patient safety and responsiveness while situating the project in the broader context of health systems performance.
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Moving forward: improving quality data systems
Future work is based on a set of papers prepared by five separate teams of internationally renowned experts in a range of clinical fields in October 2004. These papers are:
No. 18: Selecting Indicators for Patient Safety at the Health Systems Level in OECD Countries
No. 17: Selecting Indicators for the Quality of Mental Health Care at the Health Systems Level in OECD Countries
No. 16: Selecting Indicators for the Quality of Health Promotion, Prevention and Primary Care at the Health Systems Level in OECD Countries
No. 15: Selecting Indicators for the Quality of Diabetes Care at the Health Systems Level in OECD Countries
No. 14: Selecting Indicators for the Quality of Cardiac Care at the Health Systems Level in OECD Countries
A data availability survey carried out in 2005 provided the background for future work on indicators.
First, data was gathered from a limited set of new indicators from the above-mentioned papers. These indicators were then added to the HCQI Initial Indicators set.
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Second, the focus work by country experts in the above five areas is providing the basis for improving quality data systems across countries and further indicator development for the HCQI set.
Areas of immediate activity include patient safety, mental health and responsiveness.
In November 2007 the OECD released the 4th edition of the Health at a Glance publication. For the first time, this publication includes a chapter on comparable indicators of quality of care drawn from the HCQI set.
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OECD work in patient safety
A particular focus for the HCQI Project is the review, testing and reporting of data for a targeted set of indicators of patient safety that can be reliably reported across OECD countries.
This work is being undertaken in close collaboration with national and international organisations specialising in quality and patient safety, including the World Health Organization’s Global Alliance on Patient Safety, the European Commission-sponsored SIMPATIE Project and national safety organisations in OECD member countries.

The HCQI Project has recently developed a manual to facilitate cross national comparisons of indicators for patient safety through the provision of detailed practical advice on calculating each indicator in a selected set of Patient Safety Indicators utilising national hospital administrative databases. Click here to view a copy of the document.
In light of new evidence, in 2007 the OECD undertook an evaluation of the patient safety indicators to reassess the validity of the indicators originally selected by the expert panel in 2004. Based upon the US experience with hospital administrative data, a summary report has been produced on the AHRQ (Agency for Healthcare Research and Quality) experience in validating it's Patient Safety Indicators/Pediatric Quality Indicators. The document is to be used for further discussions to evaluate and improve the HCQI patient safety indicator specifications on an ongoing basis.
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OECD work in mental health care
The immediate activity for the mental health care network is collecting information at a national level on the structural context of mental health care and relevant information systems available. The aim is two-fold:
To address the gap in common concepts and definitions of mental health already detected across OECD countries.
To map out a strategy for improving mental health care data systems within the OECD and getting mental health care data on the inter/national agenda.
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OECD work in responsiveness and patient experiences
In 2007, the HCQI Project began to expand work on the measurement of responsiveness and patient experiences. Both on a national and international level numerous attempts have been made to capture patient satisfaction in systematic methods. To explore the possibilities for cross-national comparison of patient experiences, the OECD commissioned the Norwegian Knowledge Centre for the Health Services to perform a review of the use of national and international surveys to measure patient experiences. The report from this review is now available and is providing a basis for ongoing discussions regarding the future work of the HCQI Project on responsiveness and patient experiences measurement.