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Brief analytical summaries or syntheses #8

Improving and measuring quality of care

Summary

This publication presents new data on patient safety in OECD countries and shows that significant variations in quality of care persist in cancer, acute myocardial infarction and stroke, as well as in services provided by family physicians. The report looks at how countries can improve the measurement of quality, the balance between privacy and transparency in matters of quality and safety, and links between quality indicators and policies to improve the performance of physicians, hospitals and the health system as a whole.

Background

Health systems face important challenges today: an increasingly complex case mix, greater demand for health care services (especially for chronic diseases) and an economic context in which improvements in care must come at the lowest possible cost. Measuring the quality of care becomes increasingly important in this context. Poor quality care undermines the goals of modern health systems, compromises the health status of the population, and increases mortality. As well, poor quality care wastes healthcare resources, which is unacceptable at any time, but especially so when financial resources are scarce. The OECD Health Care Quality Indicators (HCQI) Project has, since 2002, provided comparable cross-national data on the quality of care. This report is part of that project.

Analysis and results

It is increasingly evident that, in many countries, health care is not evidence-based and does not follow established best practices. The result is poor quality care with negative consequences for tens of thousands of patients. However, many countries are improving the quality of health care and this progress is largely due to quality measurement.

The measurement, evaluation and comparison of quality in health care are three essential elements in the quality-led governance of health systems. The ultimate objective is to offer safe, efficient, patient-centred care.

Quality indicators developed by the OECD HCQI Project reveal the variation in quality of care between OECD countries :

  • Data available on hospitalizations for asthma, chronic obstructive pulmonary disease, diabetes and congestive heart failure show the importance of an effective primary care system.
  • Data on 30-day mortality for acute myocardial infarction and stroke show large improvements in the quality of care, though performance in some countries is still poor.
  • Data on hospital readmission for schizophrenia and bipolar disorder are highly variable between countries and raise questions about the quality of mental health care.
  • Data on patient safety raise questions about the quality of incident reporting (for example, accidental laceration or obstetrical trauma after vaginal delivery) and indicate a need for improvement to patient safety policies.

Data on cancer survival and mortality show marked improvements in care, but also significant variation between countries.

Conclusion

This report describes why quality indicators are important and how they can be used. It presents examples from different countries as to how quality-improvement initiatives can be implemented in various health systems. Notwithstanding these examples, there is still much work to be done and healthcare improvements must be adapted to each particular context. The experience reported by experts in different countries reveal a number of common lessons.

Implications and recommendations

Recommendations on the measurement of health care quality indicators
 
Access to data:

  • Develop legislation that strikes a balance between privacy and data-protection concerns and the need for reliable and valid information for quality-led governance.
  • Fully exploit the potential of national registries and administrative databases for measuring quality of care.
  • Implement the comprehensive use of electronic health records.
  • Set up national systems to collect longitudinal data on patient experiences.

Recommendations on the use of health care quality indicators

  • Assure that consistent indicators are used to take into account all improvements in the quality of care.
  • Ensure that quality measurement efforts are linked with national quality policies.
  • Seek examples of good performance from other countries and see how these could be put into practice locally.

Source

Improving value in health care: Measuring quality. Ce lien s'ouvrira dans une nouvelle fenêtre.